Renal infarction is a rare ischemic event caused by the complete or partial occlusion of the main renal artery or its segmental branches, which may ultimately lead to renal ischemia. Renal infarction most commonly occurs due to an embolus originating from the heart or an in situ thrombosis. Other etiological causes of renal infarction are aortic thromboembolism, trauma, renal artery dissection, coagulation disorders, or other atheroembolic disease.
The diagnosis of renal infarction should be considered in patients who develop sudden abdominal or flank pain with reduced renal function, elevated LDH, hematuria, or proteinuria and who do not have urolithiasis or any other diagnosable explanation for their symptoms. The chances increase if the patient has cardiac disease, especially atrial fibrillation, or is aged older than 60 years. Evaluation often starts with a noncontrast abdominal computed tomography (CT) scan, progressing to a contrast-enhanced study if the original CT scan is negative. Early diagnosis is essential for initiating revascularization therapy promptly, which optimizes renal function recovery. Treatment options include intravascular thrombolysis, systemic thrombolysis, anticoagulation, and antiplatelet therapy. Clinical presentation, underlying risk factors, length of time between symptom onset and treatment, and partial or total artery occlusion all impact the likelihood of renal recovery.
Given the overlap of clinical symptoms with more common presentations (eg, renal calculi and pyelonephritis), the diagnosis may be missed entirely; this possibility is supported by a higher incidence of renal infarction in autopsy studies compared to retrospective case reviews. An overlooked diagnosis can result in irreversible loss of renal function, as renal reperfusion therapy is ineffective in delayed presentation.
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