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Sega M, Yamashita M, Maruyama H, Taya Y, Ohgi K, Haraoka R, Hirayama K. Renal Embolism Associated with the Atrial Myxoma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:694. [PMID: 38792877 PMCID: PMC11123329 DOI: 10.3390/medicina60050694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Renal embolisms due to cardiac myxomas are extremely rare; the clinical course, treatment, and prognosis of this disease are not established. A 69-year-old Japanese woman who underwent a nephrectomy for renal cell carcinoma 3 years earlier was hospitalized with a right occipital lobe cerebral infarction. Her renal function suddenly worsened 3 days post-admission: her serum creatinine rose from 1.46 mg/dL to 6.57 mg/dL and then to 8.03 mg/dL the next day, and hemodialysis therapy was started. Abdominal computed tomography (CT) scans showed patchy non-contrasted low-density areas in the right kidney, and chest CT scans and transesophageal ultrasonography revealed a left atrial tumor. We diagnosed renal infarction due to a left atrial myxoma. Hemodialysis and anticoagulant therapy (heparin) were continued, followed by the cardiac myxoma's resection. The patient's renal function gradually improved post-surgery, and the hemodialysis was discontinued. Considering our patient and 19 other case reports of renal infarction associated with cardiac myxoma, the treatment for such a renal infarction and the outcomes differ depending on the embolus site. The poor outcome of abdominal aortic embolism requires a prompt embolectomy, whereas a branch renal artery embolism requires anticoagulation therapy to prevent thrombosis formation around the myxoma.
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Affiliation(s)
- Masatoshi Sega
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Marina Yamashita
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Hiroshi Maruyama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Yuji Taya
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kentaro Ohgi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
- Department of Intensive Care Medicine, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Rei Haraoka
- Department of Neurosurgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
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Kim DE, Moon I, Park S, Park M, Park S, Kwon SS, Kong MG, Park HW, Choi HO, Seo HS, Cho YH, Lee NH, Suh J. Temporal Trend of the Incidence and Characteristics of Renal Infarction: Korean Nationwide Population Study. J Korean Med Sci 2023; 38:e239. [PMID: 37550807 PMCID: PMC10412037 DOI: 10.3346/jkms.2023.38.e239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Large-scale studies about epidemiologic characteristics of renal infarction (RI) are few. In this study, we aimed to analyze the incidence and prevalence of RI with comorbidities in the South Korean population. METHODS We investigated the medical history of the entire South Korean adult population between 2013 and 2019 using the National Health Insurance Service database (n = 51,849,591 in 2019). Diagnosis of RI comorbidities were confirmed with International Classification of Disease, Tenth Revision, Clinical Modification codes. Epidemiologic characteristics, distribution of comorbidities according to etiologic mechanisms, and trend of antithrombotic agents were estimated. RESULTS During the 7-years, 10,496 patients were newly diagnosed with RI. The incidence rate increased from 2.68 to 3.06 per 100,000 person-years during the study period. The incidence rate of RI increased with age peaking in the 70s with 1.41 times male predominance. The most common comorbidity was hypertension, followed by dyslipidemia and diabetes mellitus. Regarding etiologic risk factor distribution, high embolic risk group, renovascular disease group, and hypercoagulable state group accounted for 16.6%, 29.1%, and 13.7% on average, respectively. For the antithrombotic treatment of RI, the prescription of antiplatelet agent gradually decreased from 17.0% to 13.0% while that of anticoagulation agent was maintained around 35%. The proportion of non-vitamin K antagonist oral anticoagulants remarkably increased from only 1.4% to 17.6%. CONCLUSION Considering the progressively increasing incidence of RI and high prevalence of coexisting risk factors, constant efforts to raise awareness of the disease are necessary. The current epidemiologic investigation of RI would be the stepping-stone to establishing future studies about clinical outcomes and optimal treatment strategies.
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Affiliation(s)
- Dong-Eon Kim
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Inki Moon
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Suyeong Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Minae Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Sojeong Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Seong Soon Kwon
- Division of Cardiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Min Gyu Kong
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Woo Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Nae Hee Lee
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jon Suh
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
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He Y, Hu Y, Tian L, Qiu C, Li D, Xiang Y, Wang X, He Y, Wang X, Shang T, Zhu Q, Chen T, Li Z, Zeng Q, Wu Z, Zhang H. Acute Renal Infarction Due to Symptomatic Isolated Spontaneous Renal Artery Dissection: A Rare and Fatal Disease. J Endovasc Ther 2023:15266028231168352. [PMID: 37154346 DOI: 10.1177/15266028231168352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To report demographics and clinical, laboratory, and imaging features of acute renal infarction (ARI) due to symptomatic isolated spontaneous renal artery dissection (SISRAD) and to analyze outcomes after the initial therapy for SISRAD. METHODS Thirteen patients with ARI due to SISRAD between January 2016 and March 2021 were enrolled in this retrospective study. We reviewed the demographics, clinical, laboratory, and imaging features (location of the infarct kidney, the branch artery involved by dissection, true lumen stenosis, false lumen thrombosis, and aneurysm), treatment modalities, and follow-up results; analyzed the difference between SISRAD and other causes of ARI; and propose an appropriate therapy strategy for SISRAD based on our data and literature. RESULT Patients with ARI due to SISRAD were mostly young men (43 [24-53] years; 12/13 [92%]). No patients had atrial fibrillation or acute kidney injury at admission (0/13). All 13 patients received conservative treatment as the initial treatment. Sixty-two percent (8/13) of patients progressed, and 88% (7/8) of them had dissection aneurysm on the admission computed tomographic angiography (CTA) image. Seventy-five percent (6/8) of patients underwent endovascular intervention as follows, stent placement in 1 patient, renal artery embolization in 1, and stent placement with embolization in 4. Two patients with disease progression died: 1 during the conservative treatment period and 1 after the stent placement. Thirty-eight percent (5/13) of patients in remission continued to receive conservative treatment, none of whom had dissection aneurysm on the admission CTA. CONCLUSION Symptomatic isolated spontaneous renal artery dissection is a rare and fatal disease. For young ARI patients with no previous history of tumors and cardiogenic diseases, CTA examination is recommended to exclude SISRAD. Dissection aneurysm seems to be a risk of progression for SISRAD in this series. Conservative treatment, a recognized initial treatment, has a good effect on patients without dissection aneurysm, and we recommend endovascular intervention as the initial treatment for the patient with dissection aneurysm at admission. Multicenter clinical studies are needed to explore a more-appropriate treatment for patients with SISRAD. CLINICAL IMPACT This article report the related factors, risks, demographics and laboratory data of Acute renal infarction (ARI) due to Symptomatic isolated spontaneous renal artery dissection (SISRAD) and explore a better initial therapy strategy for SISRAD. It will help improve the effectiveness of SISRAD treatment and reduce the mortality rate from this rare but lethal disease.
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Affiliation(s)
- Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yujian Hu
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yilang Xiang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohui Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunjun He
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xun Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tianchi Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qinglong Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Vandebeek Q, Henroteaux D, Pitance F, Bertrand X. Bilateral traumatic renal artery dissection managed by endovascular therapy. BMJ Case Rep 2022; 15:e250515. [PMID: 35835484 PMCID: PMC9289034 DOI: 10.1136/bcr-2022-250515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of post-traumatic bilateral renal artery injury with renal perfusion disorder, successfully treated by endovascular treatment. This therapeutic approach avoided the need for long-term dialysis by maintaining a sufficient renal function. This case is an illustration of the feasibility and the efficiency of endovascular treatment in severe post-traumatic renal artery lesions.
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Yihan L, Guanqi F, Tong H, Junye G, Zhong J, Chen T. Case Report: Acute Renal and Splenic Infarctions Secondary to Atrial Fibrillation. Front Cardiovasc Med 2022; 9:879322. [PMID: 35686039 PMCID: PMC9171008 DOI: 10.3389/fcvm.2022.879322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Acute renal and splenic infarctions are an uncommon condition that can result from obstruction or decrease of renal and splenic arterial flow. We described a 73-year-old woman who presented with right flank pain and nocturnal dyspnea. The computed tomography (CT) scan with intravenous contrast showed multiple infarcts in both bilateral kidneys and spleen. Serum creatinine clearance was impaired. Further investigation by electrocardiogram (ECG) and 24-h Holter revealed that the patient had paroxysmal atrial fibrillation (PAF). Transthoracic and transesophageal echocardiographic findings were unremarkable except for severe spontaneous echo contrast (SEC) in the left atrial appendage. The development of thromboembolic renal and splenic infarction was attributed to embolism caused by atrial fibrillation. Anticoagulant therapy was initiated with low molecular weight heparin (LMWH) and followed by an oral anticoagulant. To manage PAF and prevent further embolism, the “One-stop” procedure, including atrial fibrillation catheter ablation and left atrial appendage occlusion (LAAO), was applied to this patient. Follow-up at 1 month showed normal sinus rhythm, improved renal function, and relieved renal and splenic infarction.
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Lemiński A, Kubis M, Kaczmarek K, Gołąb A, Kazimierczak A, Kotfis K, Słojewski M. When Bodybuilding Goes Wrong—Bilateral Renal Artery Thrombosis in a Long-Term Misuser of Anabolic Steroids Treated with AngioJet Rheolytic Thrombectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042122. [PMID: 35206310 PMCID: PMC8872588 DOI: 10.3390/ijerph19042122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Bilateral renal infarction is an extremely rare condition with only few cases reported in the literature. We present a case of bilateral renal infarction affecting an otherwise healthy 34 year old bodybuilder chronically misusing testosterone and stanozolol. The patient presented with severe flank pain mimicking renal colic and biochemical features of acute kidney injury. Diagnostic workup revealed thrombosis affecting both renal arteries. Subsequently, the patient underwent a percutaneous rheolytic thrombectomy with AngioJet catheter, along with catheter-directed thrombolysis. Right-sided retroperitoneal hematoma developed as an early complication, mandating surgical exploration and nephrectomy due to kidney rupture and the unstable condition of the patient. Intensive care and continuous renal replacement therapy were instigated until a gradual improvement of the patient status and a return of kidney function was achieved. No abnormalities were found in the cardiological and hematological evaluation. We believe this is a first report of bilateral renal infarction associated with anabolic steroid misuse in an otherwise healthy individual, and a first report of AngioJet thrombectomy in bilateral thrombosis of renal arteries. It stresses the importance of a thorough diagnostic workup of colic patients and emphasizes the need for sports medicine to reach out to amateur athletes with education on the harms of doping.
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Affiliation(s)
- Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.K.); (K.K.); (A.G.); (M.S.)
- Correspondence: (A.L.); (K.K.)
| | - Markiian Kubis
- Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.K.); (K.K.); (A.G.); (M.S.)
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.K.); (K.K.); (A.G.); (M.S.)
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.K.); (K.K.); (A.G.); (M.S.)
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence: (A.L.); (K.K.)
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.K.); (K.K.); (A.G.); (M.S.)
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Predictors of renal infarction in patients presenting to the emergency department with flank pain: A retrospective observational study. PLoS One 2021; 16:e0261054. [PMID: 34874969 PMCID: PMC8651137 DOI: 10.1371/journal.pone.0261054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Flank pain is a common symptom in the emergency department and can be caused by a variety of diseases. Renal infarction (RI) is a very rare disease, and many RI patients complain of flank pain. However, there is no definitive predictor of RI when patients complain of flank pain. This study aimed to identify the clinical factors for predicting RI in patients with flank pain. Methods This retrospective single-center study was conducted on patients complaining of flank pain from January 2016 to March 2020 at a South Korean tertiary care hospital. Exclusion criteria included patients who did not undergo contrast-enhanced computed tomography, age < 18 years, and trauma. Demographic and laboratory data were obtained from medical records. Logistic regression analysis was conducted to identify predictors of RI occurrence. Results In all, 2,131 patients were enrolled, and 39 (1.8%) had RI. From a multivariable logistic regression analysis, an age ≥ 65 years (odds ratio [OR], 3.249; 95% confidence interval [CI], 1.366–7.725; p = 0.008), male sex (OR, 2.846; 95% CI, 1.190–6.808; p = 0.019), atrial fibrillation (OR, 10.386; 95% CI, 3.724–28.961; p < 0.001), current smoker (OR, 10.022; 95% CI, 4.565–22.001; p < 0.001), and no hematuria (OR, 0.267; 95% CI, 0.114–0.628; p = 0.002) were significantly associated with the occurrence of RI. Conclusions Five clinical factors, i.e., age ≥ 65 years, male sex, atrial fibrillation, current smoker, and no hematuria, were significantly associated with the occurrence of RI in patients with flank pain.
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Kulkarni S, Chakurkar V, Lobo V. Renal Microvascular Ischemia Secondary to Nonsteroidal Anti-inflammatory Drugs. Indian J Nephrol 2021; 31:383-385. [PMID: 34584355 PMCID: PMC8443091 DOI: 10.4103/ijn.ijn_211_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 08/07/2020] [Indexed: 11/04/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs), widely prescribed for pain, can affect kidneys in various ways. We present a case of a 37-year-old woman with multiple NSAIDs intake over a short period for dysmenorrhea followed by the development of new-onset bilateral flank pain. Computed tomography revealed bilateral multiple renal infarcts. Renal function was normal. Investigations showed no cardiac or renal artery lesion and vasculitis work-up was negative. She was treated conservatively and further NSAID intake was avoided. Follow-up scan showed complete restoration of the blood flow in previously affected areas. Thus, microvascular ischemia secondary to NSAIDs was thought to be responsible.
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Affiliation(s)
- Sagar Kulkarni
- Renal Unit, Department of Medicine, KEM Hospital, Pune, Maharashtra, India
| | - Vipul Chakurkar
- Renal Unit, Department of Medicine, KEM Hospital, Pune, Maharashtra, India
| | - Valentine Lobo
- Renal Unit, Department of Medicine, KEM Hospital, Pune, Maharashtra, India
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Ahn SB, Lee JY. Clinical differentiation between acute renal infarction and acute ureteral stone in the emergency department: A single-center retrospective case-control study. Am J Emerg Med 2021; 50:322-329. [PMID: 34428730 DOI: 10.1016/j.ajem.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few studies have compared renal infarction (RI) and ureteral stone (US), so there is insufficient evidence for emergency clinicians (ECs) to quickly suspect RI during the first assessment. Therefore, we compared the initial clinical presentation and laboratory findings of these diseases in the emergency department (ED) to determine a factor that may indicate RI. METHODS This single-center retrospective case-control study included 42 patients with acute RI and 210 with US who visited the ED from 2014 to 2020. Medical record data from first ED arrival were investigated, and clinical presentations, blood and urine test results obtained in the ED were compared and analyzed using logistic regression analysis. RESULTS ECs never suspected the initial diagnosis of RI as RI. The most common initial diagnosis was US (40.5%). Among patients with US, 150 patients (71.4%) were suspected of having US (p < 0.001). Abdominal pain (61.9%) was the most common chief complaint in the RI group, and flank pain (73.8%) was the most common in the US group (p < 0.001). 27 factors showed significant differences between the groups. Among those, age ≥ 70 years (odds ratio [OR]: 311.2, 95% confidence interval [CI]: 2.0-47,833.1), history of A-fib (OR: 149872.8, 95% CI: 289.4-7.8E+07), fever ≥37.5 °C (OR: 297.3, 95% CI: 3.3-27,117.8), Cl- ≤ 103 mEq/L (OR: 9.0, 95% CI: 1.0-80.1), albumin ≤4.3 g/dL (OR: 26.6, 95% CI: 2.1-330.3), LDH ≥500 IU/L (OR: 17.9, 95% CI: 1.8-182.5), and CRP ≥0.23 mg/dL (OR: 7.5, 95% CI: 1.1-52.3) showed significantly high ORs, whereas urine RBCs (OR: 0, 95% CI: 0-0.02) showed a low OR (p < 0.05). The regression model showed good calibration (chi-square: 6.531, p = 0.588) and good discrimination (area under the curve = 0.9913). CONCLUSIONS When differentiating acute RI from US in the ED, age ≥ 70 years, history of A-fib, fever ≥37.5 °C, LDH ≥500 IU/L, Cl- ≤ 103 mEq/L, albumin ≤4.3 g/dL, CRP ≥0.23 mg/dL and negative urine RBC result suggest the possibility of RI.
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Affiliation(s)
- Seung Bae Ahn
- Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Jang Young Lee
- Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
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ÇETİNKAYA HB, ALATLI T. Laboratory parameters can be used to differentiate renal infarction and urolithiasis in patients who are admitted to the emergency department with flank pain. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.926837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Faustich JTS, Carney JP, Lahti MT, Zhang BL, Bianco RW. Establishing Background Pathologic Changes of Valve Replacement Surgery in Sheep. Cardiovasc Eng Technol 2021; 13:181-190. [PMID: 34263418 PMCID: PMC8888364 DOI: 10.1007/s13239-021-00563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022]
Abstract
Purpose Sheep are the standard preclinical model for assessing safety of novel replacement heart valves, yet the anatomic and pathologic effects of invasive surgery, including those involving cardiopulmonary bypass (CPB), are unknown. Thus, we aimed to determine the gross, hematologic and biochemical effects of sham mitral and aortic replacement valve procedures in sheep to establish a useful control for evaluation of novel replacement valves. Methods Six control sheep were examined without any surgical intervention. Six sham mitral valve replacements (MVR) and six sham aortic valve replacements (AVR) were performed on 12 sheep. Complete blood counts and serum biochemistry were performed throughout the study. Sheep were sacrificed with a necropsy performed at 90 days. Results Renal infarcts (RIs) were the most frequently observed lesion, averaging 4.7 in control sheep, 2.5 with MVR and 5.8 with AVR. The number of infarcts strongly correlated with total estimated area of infarcted kidney (r = .84, p < .01). Additional cardiac interventions were significantly correlated with increased numbers of RIs (r = .85, p < .01). There was no correlation between number of RIs and time on CPB, or between AVR and MVR procedures. Conclusion The sheep model for AVR and MVR requires invasive surgery and CPB, which are associated with background anatomic and pathologic changes, especially in cases with additional surgical cardiac interventions. These findings serve as a critical control for future evaluation and development of novel replacement valves in order to distinguish device-related safety issues from expected outcomes of the surgical procedure and normal background changes in sheep. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00563-6.
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Affiliation(s)
- Jill T Schappa Faustich
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - John P Carney
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Matthew T Lahti
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Benjamin L Zhang
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Richard W Bianco
- Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA
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Delezire A, Terrasse M, Bouet J, Laot M, Brun V, Oger E, Vigneau C. Acute renal infarction: long-term renal outcome and prognostic factors. J Nephrol 2021; 34:1501-1509. [PMID: 33765299 DOI: 10.1007/s40620-020-00953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute renal infarction is a rare occurence, whose prognosis and long-term outcomes remain poorly studied. This study evaluated whether clinical and radiological features at diagnosis can be associated with the long-term outcomes (blood pressure, kidney function and mortality). METHODS We retrospectively analyzed the demographic, clinical, biological and radiological data of patients with acute renal infarction hospitalized at Rennes University Hospital between 1997 and 2017 (n = 94). RESULTS Patients were followed-up for a median of 60 months. At time of diagnosis of acute renal infarction median age was 53 years, 45% of the patients had acute hypertension, and 31% had Acute Kidney Injury (AKI) requiring dialysis in seven patients. The median Lactate DeHydrogenase (LDH) level was 977 IU/mL. The median extent of kidney damage was 14%, with left renal involvement in 51% of patients. At 60 months of follow-up, 66% of patients had developed Chronic Kidney Disease (CKD) stage 3 or higher, and 55% had hypertension since diagnosis. Age, acute development of hypertension and AKI at diagnosis were associated with long-term CKD (stage 3 or higher) in multivariate analyses, but the extent of kidney damage was not. During the follow-up, 21% of patients died, and only age resulted as a predisposing factor. No tested factor was correlated with long-term hypertension. DISCUSSION Age, acute development of hypertension, and AKI were correlated with long term CKD, whereas no factor was correlated with long-term hypertension after acute renal infarction.
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Affiliation(s)
- Arnaud Delezire
- Service de Néphrologie, CHU Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France.
| | - Marianne Terrasse
- Service de Néphrologie, CHU Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Julien Bouet
- Centre Hospitalier Public du Cotentin, Service de Néphrologie, Rue Trottebec, BP 208, 50102, Cherbourg Octeville Cedex, France
| | - Maxence Laot
- CHU Hôpital Pontchaillou, Service d'Imagerie médicale, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Vanessa Brun
- CHU Hôpital Pontchaillou, Service d'Imagerie médicale, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Emmanuel Oger
- Faculté de Médecine, Université Rennes 1, Équipe de Pharmacoépidémiologie, INSERM CIC 0203, 2 avenue du Professeur Léon Bernard, CS 34317, 35043, Rennes Cedex, France.,Centre Régional de Pharmacovigilance, CHU Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Cécile Vigneau
- Service de Néphrologie, CHU Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France.,Université Rennes 1, INSERM, U1085 IRSET-9, 35033, Rennes, France
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13
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Haoudar A, Ziati J, Makani S, Agrad K, El Kettani C. Acute Bilateral Renal Infarction: An Unusual Complication After Mitral Valve Replacement Surgery. Cureus 2021; 13:e14037. [PMID: 33898123 PMCID: PMC8059103 DOI: 10.7759/cureus.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bilateral renal infarction is an uncommon clinical condition that is frequently misdiagnosed. Its various mechanisms mainly include thrombotic and embolic. We report the case of a 51-year-old Moroccan woman, who presented with acute bilateral renal infarction three days following mitral valve replacement surgery of probable embolic origin despite curative heparin. Her renal function did not improve, and the patient developed chronic renal failure. Diagnosing bilateral renal infarction is challenging, especially in the postoperative period of mechanical mitral valve replacement surgery. Curative heparin therapy does not totally protect (100%) against this serious complication. This case study aimed to raise awareness of this rare clinical condition after cardiac surgery.
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Affiliation(s)
- Amal Haoudar
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Jihane Ziati
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Said Makani
- Cardiac Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Khalid Agrad
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Chafik El Kettani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
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14
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Añazco PH, Balta FM, Córdova-Cueva L. Bilateral renal infarction in a patient with severe COVID-19 infection. ACTA ACUST UNITED AC 2021; 43:127-131. [PMID: 33460428 PMCID: PMC8061971 DOI: 10.1590/2175-8239-jbn-2020-0156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Abstract
Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.
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Affiliation(s)
- Percy Herrera Añazco
- Hospital Nacional 2 de mayo, Departament of Nephrology, Lima, Perú.,Universidad Señor de Sipán, Chiclayo, Peru
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15
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Lu X, Yuan C, Li R. Multiple renal infarctions in a patient caused by granulomatosis with polyangiitis. J Int Med Res 2020; 48:300060520977449. [PMID: 33322993 PMCID: PMC7745613 DOI: 10.1177/0300060520977449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a small-vessel vasculitis that is highly associated with anti-neutrophil cytoplasmic antibodies. GPA carries an increased risk of organ infarction, but renal infarction is rare. We herein describe a case of multiple renal infarctions caused by GPA. A 66-year-old man presented with hearing loss, nasal discharge, fatigue, and weight loss for several months. Cross-sectional contrast-enhanced computed tomography images revealed multiple low-attenuation areas in both kidneys. He subsequently developed fever and impaired renal function. Blood serum was positive for cytoplasmic anti-neutrophil cytoplasmic antibody and a renal biopsy showed granulomatous necrotizing vasculitis. He was diagnosed with GPA and treated with high-dose corticosteroids, plasma exchange, and cyclophosphamide. The patient ultimately entered clinical remission.
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Affiliation(s)
- Xiao Lu
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - ChengYing Yuan
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - RongShan Li
- Nephrology Division, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
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16
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KARTAL İ, ALKIŞ O, ÇETİNKAYA B, ÇELEN S, ARAS B. Clinical Approach to Renal Artery Thromboembolism. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.761573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Ivanes F, Dewaele J, Touboul C, Gatault P, Sautenet B, Barbet C, Büchler M, Quilliet L, Angoulvant D, Halimi JM. Renal arteriography with endovascular ultrasound for the management of renal infarction patients. BMC Nephrol 2020; 21:273. [PMID: 32664890 PMCID: PMC7362568 DOI: 10.1186/s12882-020-01929-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background Renal infarction (RI) is a rare disease with poor prognosis. Appropriate secondary prevention treatment is essential and requires an exhaustive etiological assessment. We aimed to determine whether invasive endovascular explorations may improve the diagnostic process and change the secondary prevention treatment strategy in RI patients. Methods We report a retrospective observational study of 25 RI patients referred to Tours University Hospital between 2011 and 2018 for etiological investigation including renal arteriography and intravascular ultrasonography (IVUS). We sought for antithrombotic treatment regimen, vital status, bleeding and ischemic outcomes during the median follow-up of 59 months. Results Invasive explorations showed local arterial disease in 14 patients (56%). This led to a diagnosis or change in diagnosis in 9 patients (36%) and to a change in antithrombotic strategy in 56% of cases, with an increased prescription of antiplatelet therapy. No patient died, only two patients (8%) had persistent mild renal insufficiency. One IVUS complication was reported and treated without any significant long-term consequences. Conclusion Invasive endovascular investigations of RI may modify the secondary prevention treatment through a better assessment of the aetiology of RI. Multicentric randomized studies are necessary to advocate the hypothesis that invasive exploration of renal artery can improve long-term prognosis.
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Affiliation(s)
- Fabrice Ivanes
- Department of Cardiology, CHRU Tours, Tours, France. .,EA 4245 T2I & Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France.
| | - Jean Dewaele
- Department of Cardiology, CHRU Tours, Tours, France
| | | | - Philippe Gatault
- EA 4245 T2I & Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France.,Department of Nephrology, CHRU de Tours, Tours, France
| | | | | | - Matthias Büchler
- EA 4245 T2I & Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France.,Department of Nephrology, CHRU de Tours, Tours, France
| | | | - Denis Angoulvant
- Department of Cardiology, CHRU Tours, Tours, France.,EA 4245 T2I & Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
| | - Jean-Michel Halimi
- EA 4245 T2I & Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France.,Department of Nephrology, CHRU de Tours, Tours, France
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18
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Reversible renal infarctions associated with pheochromocytoma: a case report. Chin Med J (Engl) 2020; 133:1481-1482. [PMID: 32496301 PMCID: PMC7339374 DOI: 10.1097/cm9.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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