A case series of acute renal infarction at a single center in Japan

Clin Exp Nephrol. 2016 Jun;20(3):411-5. doi: 10.1007/s10157-015-1168-1. Epub 2015 Sep 16.

Abstract

Background: The prevalence of acute renal infarction (ARI) in Japan remains unclear. We describe the clinical features and renal prognosis of ARI in Japanese patients.

Methods: This single-center, retrospective, observational study included 33 patients with newly diagnosed ARI (2009-2013). Their clinical features and long-term renal outcomes were evaluated.

Results: The prevalence of ARI among emergency room patients was 0.013 %. The incidence of ARI among in-patients was 0.003 % (mean age 71.9 ± 13.4 years; men 63 %). Enhanced computed tomography or renal isotope scans were obtained to diagnose ARI. ARI involved the left kidney in 70 %, right kidney in 18 %, and both kidneys in 12 % of patients. Four cases had splenic infarction, and 70 % of patients had atrial fibrillation. We noted abdominal or flank pain in 66 %, fever (>37.6 °C) in 36 %, and nausea/vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset. Acute kidney injury due to ARI occurred in 76 % of patients. The estimated glomerular filtration rate decreased to ~70 % and recovered to ~80 % of the original value after 1 year. The mortality rates were 9 and 15 % at 1 month and 1 year, respectively.

Conclusions: We determined the prevalence of ARI among emergency room patients, its incidence among in-patients, and short-term and long-term mortality. The majority of ARI cases were of cardiac origin, and the others were due to trauma or systemic thrombotic disease. Clinicians should recognize ARI as a fatal arterial thrombotic disease.

Keywords: Acute kidney injury; Arterial thrombosis; Renal infarction.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / blood
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / epidemiology*
  • Arterial Occlusive Diseases / mortality
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Comorbidity
  • Emergency Medical Services
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Infarction / blood
  • Infarction / diagnostic imaging
  • Infarction / epidemiology*
  • Infarction / mortality
  • Inpatients
  • Japan / epidemiology
  • Kidney / blood supply*
  • Kidney / metabolism
  • Kidney / physiopathology
  • L-Lactate Dehydrogenase / blood
  • Leukocyte Count
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Radioisotope Renography
  • Retrospective Studies
  • Risk Factors
  • Thrombosis / blood
  • Thrombosis / diagnostic imaging
  • Thrombosis / epidemiology*
  • Thrombosis / mortality
  • Time Factors
  • Tomography, X-Ray Computed

Substances

  • Biomarkers
  • C-Reactive Protein
  • L-Lactate Dehydrogenase