Abstract: PUB043
Renal Infarction: A Case Series Highlighting Diverse Etiologies and Diagnostic Challenges
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Syed, Jahanghir, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Lwin, Yone Mee Mee, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Safi, Adnan, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Nenwani, Hari Vishal, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Akatibo, Emmanuel, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Kouyate, Gnama, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Azhar, Muhammad, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Mohamed, Ibrahim A., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Puri, Isha, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Mallappallil, Mary C., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Salifu, Moro O., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
- Saggi, Subodh J., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States
Introduction
Renal infarction is an uncommon and frequently underrecognized cause of acute flank or abdominal pain. Its presentation often mimics nephrolithiasis, pyelonephritis, or other more common conditions, resulting in delayed diagnosis. Early recognition is essential to prevent irreversible renal injury and identify underlying thromboembolic or hypercoagulable states.
Case Description
We describe 3 patients with renal infarction caused by distinct etiologies. Case 1 was a 40-year-old man presenting with sudden abdominal pain radiating to the left testicle, acute kidney injury, and bilateral wedge-shaped cortical perfusion defects on contrast-enhanced CT. Duplex ultrasound demonstrated left renal artery thrombosis. Extensive evaluation was unrevealing, and chronic cigarette smoking was considered the likely contributing factor. Case 2 was a 75-year-old man with diabetes, hypertension, peripheral arterial disease, prior stroke, and recently diagnosed atrial fibrillation whose anticoagulation had been discontinued because of gastrointestinal bleeding. He presented with worsening abdominal pain, acute kidney injury, elevated lactate and LDH, and complete infarction of the left kidney due to an occlusive renal artery thrombus, consistent with a cardioembolism. Case 3 was a 55-year-old woman with 3 days of flank pain and preserved renal function whose imaging demonstrated segmental left renal infarction. Hypercoagulable evaluation revealed persistently low protein S activity, suggesting an underlying thrombophilia. All patients were treated with systemic anticoagulation.
Discussion
These cases highlight the heterogeneity of renal infarction with respect to age, presentation, and etiology, including smoking-related thrombosis, cardioembolism from atrial fibrillation, and protein S deficiency. Renal infarction should be considered in patients with unexplained flank or abdominal pain, particularly when accompanied by acute kidney injury, elevated LDH, hematuria, or proteinuria. Contrast-enhanced CT remains the diagnostic modality of choice. Prompt diagnosis and etiologic evaluation are critical to guide management and reduce the risk of recurrent thromboembolic events and permanent renal impairment.