Abstract: FR-PO012

Idiopathic Renal Infarction

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Chornyy, Volodymyr, University of Florida , Gainesville, Florida, United States
  • Koratala, Abhilash, University of Florida , Gainesville, Florida, United States
Background

Renal infarction is a rare condition that typically presents with back pain, flank or abdominal pain, hematuria and laboratory abnormalities such as leukocytosis, high CRP and elevated LDH. Most common causes of renal infarction are cardiac conditions such as atrial fibrillation, ischemic or valvular heart disease followed by other etiologies including hypercoagulable states and renal artery dissection. Interestingly no cause can be found in about a third of patient. Herein, we present a case of idiopathic renal infarction, which presented without the classic laboratory abnormalities.

Methods

A 42-year-old man with a history of hypertension has presented with nausea and abdominal pain for 2 days. Approximately 6 months prior to presentation, he was diagnosed with deep venous thrombosis of the right leg and was treated with warfarin for 3 months. Notably, he had similar pain at that time but of lesser intensity and no abdominal imaging was done. He was afebrile and urinalysis was negative for blood or WBC. Serum creatinine was 0.7 mg/dL and LDH, CRP normal. CT scan of the abdomen without contrast showed possible bilateral renal infarcts. MRA of the abdomen was performed which showed subacute bilateral focal infarcts in both the kidneys with a new wedge-shaped infarct in the right kidney (Figure 1A). Aorta and branch vessels demonstrated normal vascular enhancement without evidence for wall thickness, aneurysm or stenosis (Figure 1B). EKG showed sinus rhythm and telemetry monitoring during his inpatient stay did not show any arrhythmia. ANA, ANCA, viral hepatitis panel, HIV test were negative. Hypercoagulability work up was essentially negative. He was discharged on oral anti-coagulation.

Conclusion

Our case emphasizes the fact that high index of suspicion is required to diagnose renal infarction in patients presenting with abdominal pain. Early recognition is important because it may have long-term implications on kidney health.