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Renal infarction (RI) is a disease caused by obstruction of the renal artery or the lack of renal artery blood flow, and it can lead to kidney failure or death if its diagnosis is delayed. Because RI is a very rare condition that occurs in 0.004–0.007% of patients visiting the emergency department (ED), it is very difficult for emergency clinicians (ECs) to suspect RI. It should be considered in the diagnosis of nephretic colic. We reported a case of a 52-year-old man who consulted for flanck pain.
Case report of a 52-year-old man, previously healthy, an athlete, using testosterone for muscle mass increase (without medical supervision), who came to the emergency department with a report of severe left flanck pain, starting 30 minutes before arriving at the service, associated with mild dysuria. Physical examination revealed a painful wrist-percussion on the left.Decided to perform a computed tomography scan of the abdomen and pelvis as well as laboratory tests and analgesia. Laboratory tests showed hemoglobin level of 18,7 g/dL, white blood cell count of 15.750/mm³ and creatinine of 2,2mg/dL (CKD-EPI: 35ml/min/1,73m²). CT scan showed signs of occlusion in the anteropileal branch of the left renal artery, with extensive hypodense areas in the renal parenchyma suggestive of renal infarction associated with small hypodense areas in the parenchyma of the right kidney that may be related to perfusion alterations. There was also an exophytic expansive lesion in the upper third of the right kidney, with regular contours, finely heterogeneous, without significant contrast enhancement, measuring 7.3 x 6.4 cm, which was undetermined by the method, questioning the possibility of a mitotic lesion or a cyst with hyperprotein content.
The patient was transferred to the intensive care for pain refractory to opioids and for clinical surveillance. As it was an acute case of renal infarction on the left kidney with a possible neoplasic lesion on the right, a hospital transfer to the hemodynamics service was chosen. Angioplasty of the left renal artery with stent implantation was performed successfully, without complications, and the decision was made to introduce anticoagulation with rivaroxaban 15mg/day. New laboratory tests fifteen days after angioplasty showed creatinine of 1.5mg/dL. (CKD-EPI 55ml/min1,73m²).
Renal infarction is a rare condition and in most cases the diagnosis is delayed. It is important to remember that clinical suspicion and rapid diagnosis can be essential for maintaining good renal function.