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Renal infarction

From Surgopaedia

May involve the whole kidney (renal artery occlusion) or small areas of cortex and medulla

Aetiology

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  • Trauma
  • Embolism
    • AF
    • Atrial or mural thrombi
    • Intracardiac mass
    • Valvular lesions
  • Iatrogenic complications of endovascular procedures
  • Thrombotic
    • Atherosclerotic disease of aorta/renal arteries
    • Fibromuscular hyperplasia
    • Takayasu's arteritis
    • Polyarteritis nodosa
    • Marfan's syndrome
    • Ehler's-Danlos syndrome
    • Hypercoagulable states
    • Inflammatory diseases of retroperitoneum

Presentation

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  • 25% asymptomatic
  • Loin/flank/abdominal pain
  • Nausea and vomiting
  • Hypertension secondary to abrupt release of renin from infarcted segment
  • AKI
  • Fever, leucocytosis

Investigation

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  • Urinalysis - proteinura and haematuria
  • CT with IV contrast - look for areas of cortex not perfused

Management

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  • Usually conservative
  • Identify underlying cause
    • ECG
    • TTE
    • Potential vasculitis screen
  • Treat any hypercoagulable states/embolic syndromes with anticoagulation if necessary


Renal vein thrombosis

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  • Rare
  • Aetiology:
    • Children - severe dehydration
    • Nephrotic syndrome
    • Renal tumours
    • Hypercoagulable states
    • Surgery
    • Trauma to renal vessels
  • Management
    • Systemic anticoagulation
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