Renal infarction (death of the kidney)

Pelvis | Urology | Renal infarction (death of the kidney) (Disease)


Description

Renal infarction usually occurs in patients with severe atherosclerosis or heart disease or rarely, in association with autoimmune diseases. Hypercoagulable status can contribute to vascular occlusions. The presentation of renal infarction is usually confused with nephrolithiasis and the diagnosis is often delayed or missed.

Causes and Risk factors

A renal infarction results from disruption of blood flow to the kidney. A renal infarct can result from a number of causes and need to be distinguished from lobar nephronia and renal tumours. Causes of renal infarction include: thromboembolism (most common), aortic dissection, renal artery dissection, fibromuscular dysplasia (FMD), trauma, iatrogenic. Local renal arterythrombosis can be spontaneous or secondary to trauma.

Diagnosis and Treatment

Renal infarction is often diagnosed late. The reason is that symptoms are non-specific. Patients often have abdominal or flank pain. The diagnosis of renal infarction is suggested by an elevated LDH. The diagnosis itself is typically made with computed tomography.

Treatment depends on the cause of the infarction. In more that 90% of the cases, the embolus comes from the heart, where specific treatment will abort further embolizations. Other causes like lupus erythematosus or anti-phospholipid disease need steroids and anticoagulant therapy. In idiopathic cases, surgical embolectomy in experienced hands may be a good option. Intra-arterial thrombolytic therapy has been tried successfully. ...