Renal Infarction: multicentric cases in Piedmont


We describe factors associated to renal infarction, clinical, instrumental and laboratoristic features, and therapeutic strategies too.

This is an observational, review and polycentric study of cases in Nephrologic Units in Piedmont during 2013-2015, with diagnosis of renal infarction by Computed Tomography Angiography (CTA).

We collected 48 cases (25 M, age 57±16i; 23 F age 70±18, p = 0.007), subdivided in 3 groups based on etiology: group 1: cardio-embolic (n=19) ; group 2: coagulation abnormalities (n= 9); group 3: other causes or idiopathic (n=20).

Median time from symptoms to diagnosis, known only in 38 cases, was 2 days (range 2 hours- 8 days). Symptoms of clinical presentation were: fever (67%), arterial hypertension (58%), abdominal o lumbar pain (54%), nausea/vomiting (58%), neurological symptoms (12%), gross hematuria (10%).

LDH were increased (>530 UI/ml) in 96% of cases (45 cases out of 47), PCR (>0.5 mg/dl) in 94% of cases (45 out of 48), and eGFR <60 ml/min in 56% of cases (27 out of 48). Comparison of the various characteristics of the three groups shows: significantly older age (p=0.0001) in group 1 (76±12 years) vs group 2 (54±17 years) and group 3 (56±17 years); significantly more frequent cigarette smoking (p = 0.01) in group 2 (67%; 5 cases out of 9) and group 3 (60%; 12 cases out of 20) than group 1 (17%). No case has been subjected to endovascular thrombolysis. In 40 out of 48 cases, anticoagulant therapy was performed after diagnosis: in 12 (32%) cases no treatment, in 12 cases (30%) heparin, in 8 cases (20%) low molecular weight heparin, in 4 cases (10%) oral anticoagulants, in 3 cases fondaparinux (7%), in 1 case (2%) dermatan sulfate. Conclusions: Although some characteristics may guide the diagnosis, latency between onset and diagnosis is still moderately high and is likely to affect timely therapy. Keywords: renal infarction, kidney failure, atrial fibrillation, coagulopathy

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L’infarto renale è una patologia rara, caratterizzata dalla brusca interruzione del flusso nell’arteria renale o in uno dei suoi rami, con ischemia e necrosi del parenchima. La sua prevalenza è stata stimata nell’1.4% in uno studio autoptico molto datato (1), mentre due studi più recenti basati sulle diagnosi di ammissione in Dipartimenti di Emergenza hanno riscontrato un’incidenza rispettivamente del 0.004% e del 0.007% (2, 3). E’ possibile che la reale frequenza dell’infarto renale sia più elevata, in quanto si tratta di una patologia di difficile diagnosi a causa della possibile confusione con altre condizioni come la colica renale, la pielonefrite acuta e l’addome acuto. Inoltre, per questi motivi, la latenza tra esordio e diagnosi è spesso elevata (4), compromettendo le possibilità terapeutiche e condizionando la prognosi. 

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