The clinical spectrum of acute renal infarction.

摘要: Background: Acute renal infarction is an oft-missed diagnosis. As a result, its true incidence, although presumed to be low, actually unknown. Surprisingly, the medical literature on subject, other than anecdotal case reports, scarce. Objectives: To increase physician awareness of diagnosis and identify predictive clinical laboratory features entity. Method: Between 1 November 1997 31 October 2000, 11 cases acute in 10 patients were diagnosed our center by contrast-enhanced computerized tomography. The charts these reviewed regarding risk factors, presentation, possible examinations, outcome. Results: During 36 month observation period, incidence was 0.007%. mean age (5 men 5 women) 67.4 +/- 21.1 (range 30-87 years). In four right five left kidney involved; two bilateral involvement seen. 7/10 patients, increased for thromboembolic events found. Six had chronic atrial fibrillation one combined activated protein C resistance S deficiency. Three suffered previous event. Two receiving anticoagulant therapy with INR 1.6 1.8, respectively. On admission, flank pain recorded 10/11, fever nausea/vomiting 4 cases. Hematuria detected urine reagent strips all Serum lactate dehydrogenase white blood cell count elevated (1,570 703 IU/L 12,988 3,841/microliter, respectively). no initially entertained. working diagnoses colic 2, pyelonephritis 3, carcinoma, digitalis intoxication, suspected endocarditis patient each, abdomen 3. Time from admission definitive CT ranged 24 hours 6 days. treated intravenous heparin another combination i.v. intra-arterial urokinase infusion with, latter case, recovery function affected kidney. With exception this (with contralateral contracted kidney) who required maintenance dialysis, serum creatinine levels remained unchanged or reverted baseline 1.1 mg/dl (0.9-1.2). Conclusions: not as rare previously assumed. entity often misdiagnosed. Unilateral thromboembolism should raise suspicion infarction. such setting, hematuria, leucocytosis LDH level are strongly supportive