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Renal infarction is a rare pathology, threatening the functional prognosis of the kidney. Given the lack of clinical features specific to this pathology, the practitioner may wrongly diagnose pyelonephritis or other causes of abdominal pain. Renal infarction frequently occurs in patients with thromboembolic risk factors, most often secondary to atrial fibrillation. We report the case of a 49-year-old patient, with no previous history, who presented to the emergency room with palpitations and pain in the right flank with an atrial fibrillation rhythm on the ECG, in whom abdominal CT angiography showed signs of a focal renal infarction of the right kidney. Later, the progression was towards non-traumatic macroscopic hematuria with preservation of normal renal function, which resolved spontaneously after a few days. AF was accepted in the face of significant dilatation of the left atrium, in consultation with the patient, and he was put on a beta-blocker to control the rate. Renal infarction must be considered despite its rarity to initiate adequate treatment and increase the chances of renal rescue.

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. [ABSTRACT FROM AUTHOR]

Renal infarction is a rare pathology, which can be life-threatening for the kidney. Its low incidence and non-specific clinical manifestations make it difficult to diagnose, often resulting in delayed or misdiagnosis. Contrast-enhanced CT has a role to play in early positive diagnosis, enabling rapid and effective management. We report the case of a right renal infarction simulating renal colic, with a review of the literature.

Introduction: The presence of a hypercoagulable state predisposes to venous and arterial thrombi. While the relationship between protein C and S deficiencies with venous thrombus formation is clear, the relationship to arterial thrombi formation is less common. Thromboembolic disease of the renal arteries may result in renal infarction. The development of simultaneous bilateral renal infarction is rare and can lead to significant morbidity and mortality. Case Report: This is a case of a 48-year-old male with known protein C deficiency who presented to the emergency department with sudden onset abdominal pain. A computed tomography angiogram of the abdomen showed bilateral renal infarctions. The patient required significant analgesia and developed acute kidney injury. He was treated conservatively, and dialysis was not required. Conclusion: There are no reports in the emergency medicine literature of bilateral renal infarction secondary to protein C and S deficiency. Prompt evaluation with definitive imaging is necessary for patients who are at high risk for arterial thrombi and present with symptoms suggestive of the diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Hiccups are common symptoms that last for less than 48 hours. However, we encountered a case of renal infarction in a patient with prolonged hiccup. The relationship between hiccups and renal infarction is important in differentiating patients with prolonged hiccups. Case presentation An 87-year-old Japanese man with atrial fibrillation and receiving antithrombotic therapy presented to the emergency department with prolonged hiccups. The patient discontinued antithrombotic therapy for atrial fibrillation due to subcortical bleeding, after which he experienced right back pain. He was diagnosed with right renal infarction based on computed tomography images, and the antithrombotic therapy was continued. The patient’s hiccups ceased, and he was discharged on hospital day 11. Conclusion Hiccups can be induced by various clinical conditions. It is hypothesized that the inflammation of the right kidney infarction stimulated the diaphragm and induced prolonged hiccups in this patient; this theory is supported by the computed tomography images. This case report shows that internal organ diseases irritating the diaphragm can cause hiccups, and renal disease should be considered in patients with prolonged hiccups.

Background: Hiccups are common symptoms that last for less than 48 hours. However, we encountered a case of renal infarction in a patient with prolonged hiccup. The relationship between hiccups and renal infarction is important in differentiating patients with prolonged hiccups. Case presentation: An 87-year-old Japanese man with atrial fibrillation and receiving antithrombotic therapy presented to the emergency department with prolonged hiccups. The patient discontinued antithrombotic therapy for atrial fibrillation due to subcortical bleeding, after which he experienced right back pain. He was diagnosed with right renal infarction based on computed tomography images, and the antithrombotic therapy was continued. The patient's hiccups ceased, and he was discharged on hospital day 11. Conclusion: Hiccups can be induced by various clinical conditions. It is hypothesized that the inflammation of the right kidney infarction stimulated the diaphragm and induced prolonged hiccups in this patient; this theory is supported by the computed tomography images. This case report shows that internal organ diseases irritating the diaphragm can cause hiccups, and renal disease should be considered in patients with prolonged hiccups. [ABSTRACT FROM AUTHOR]

Renal infarction is a rare condition often misdiagnosed as more common renal disorders due to similar symptoms. This case report highlights a 52-year-old patient who presented with severe lumbago and was diagnosed with segmental renal infarction in the upper pole of the left kidney. The patient's clinical course, diagnostic evaluation, and multidisciplinary management are described. The importance of early diagnosis through imaging techniques, such as computed tomography, is emphasized. Treatment strategies, including anticoagulation and pain management, are discussed. This case underscores the need for a high index of suspicion to ensure timely diagnosis and appropriate management of renal infarction.

Background: Left upper lobectomy (LUL) is considered a risk factor for thrombus formation in the pulmonary vein stump compared with other lobectomies, and it occurs in 11.7–13.5% of cases. Although cerebral infarction after LUL has been reported in many articles, reports of bilateral renal infarction after lobectomy are rare. Case presentation: A 70-year-old male patient was admitted to our hospital with a diagnosis of lung cancer. The nodule's diameter was 2.5 cm on computed tomography, and it was diagnosed as a non-small cell lung carcinoma by a bronchoscopic biopsy. The clinical stage was cT1c N0M0 (c-stageIA3). The patient underwent thoracoscopic LUL and systemic lymph node dissection. No complications were observed during the operation, and the immediate postoperative period was uneventful until postoperative day 3. On postoperative day 4, he experienced fever, abdominal pain, and nausea, which spontaneously resolved. Laboratory data showed an elevated white blood cell count, and elevated serum lactate dehydrogenase and creatinine concentrations. Contrast-enhanced computed tomography from the thorax to the pelvic cavity showed a partial defect of the bilateral kidneys. We diagnosed the patient with bilateral renal infarction. Conclusions: Bilateral renal infarction after lobectomy is a rare and serious condition, which should be diagnosed as early as possible. Since all cases of reported renal infarctions occurred after LUL, special attention should be paid to postoperative management after performing LUL. [ABSTRACT FROM AUTHOR]

Background. IgA vasculitis (IgAV) is a multisystemic small vessel vasculitis and is the most common vasculitis in childhood. The characteristic findings of IgAV are palpable purpuric rash, abdominal pain, arthralgia or arthritis, and hematuria. Ischemic complications are very rare in IgAV. Thrombotic complications can be observed after a COVID-19 infection. Also in the presence of familial Mediterranean fever, IgAV may have an atypical or more severe course. Case. We present a case of IgAV complicated with renal infarction and intestinal ischemia. There was no recent or distant history of COVID-19 in the patient or family members, but the patient's COVID-19 antibody was positive. In addition, MEFV gene analysis of the patient showed homozygous M694V mutation. The patient did not respond to enoxaparin, pulse methylprednisolone, intravenous immunoglobulin (IVIG), iloprost, and cyclophosphamide treatments. She was successfully treated with six sessions of plasmapheresis. Conclusions. Plasmapheresis seems to be an effective treatment option in IgAV-related ischemic findings that do not respond to intensive immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

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.

Isolated spontaneous renal artery dissection (ISRAD) is a rare clinical phenomenon that typically presents with refractory hypertension and abdominal and flank pains but may also induce hematuria and severe headache. The protean manifestations of ISRAD may be misinterpreted as renal colic or intrabdominal pathology and requires a high index of clinical suspicion. Computerized tomography (CT), coupled with angiography (CTA) clarifies the diagnosis. No evidence-based management exists as intervention is reserved for persistent symptoms despite optimal medical treatment. The sporadic incidence remains limited to but a few cases illustrating endovascular management. Herein between 2014 and 2019 are presented three, healthy Caucasian males, ages from 47 to 54 years-old who presented with symptomatic ISRAD, coupled with limited renal infarctions, and treated with mid-renal and segmental arterial stenting.

Purpose: The association between COVID-19 and hypercoagulability is well established. This is a case of a patient with systemic lupus erythematosus (SLE) who developed unilateral renal vein thrombosis following COVID-19, the third case described in the international literature so far. Methods: Clinical, laboratory characteristics and outcomes of the patient were described in detail. Literature review was performed on MEDLINE database via Pubmed. Search items included COVID-19, renal infarction, and renal thrombosis. A total of fifty-three cases were located. Of these, only two patients had renal vein thrombosis but none of them carried a diagnosis of SLE. However, six cases have been published so far involving SLE patients in whom thromboembolic events developed following COVID-19, but none of them experienced renal vein thrombosis. Conclusion: The present case adds a new piece to the emerging puzzle of COVID-19 associated hypercoagulability, especially among patients with autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: Renal infarction is an extremely rare disease. Although more than 95% of cases are symptomatic, there have been no previously reported asymptomatic cases, without any abnormal blood and urine test findings. Furthermore, the efficacy of long-term treatment of idiopathic renal infarction remains unknown. Case Presentation: A 63-year-old Japanese male underwent laparoscopy; a very low anterior resection of the rectum for lower rectal cancer (stage II) four years and five months prior to diagnosis with renal infarction. During the follow-up imaging studies, asymptomatic idiopathic renal infarction was found incidentally. The blood and urine test findings were normal. Contrast-enhanced computed tomography revealed a linearly bordered area of poor contrast in the dorsal region of the right kidney; however, no renal artery lesions, thromboembolic disease, or coagulation abnormalities were observed. Initial treatment with rivaroxaban 15 mg/day resulted in the remission of the infarcted lesion. The anticoagulation therapy was terminated after about 18 months without any incidences of re-infarction or bleeding events. Conclusions: We reported a very rare case of asymptomatic idiopathic renal infarction where blood and urine tests revealed no abnormal findings, and it was diagnosed incidentally during a post-treatment follow-up examination for lower rectal cancer. Long-term anticoagulant therapy for idiopathic renal infarction should be terminated at an appropriate time, taking the risk of bleeding into account. [ABSTRACT FROM AUTHOR]

Abstract Background Thrombosis of the pulmonary vein stump is a common complication after a left upper lobectomy and can be a source of embolism in various organs, such as the kidneys. A renal infarction, on the other hand, is a rare and often lethal condition that is usually diagnosed postmortem. Here, we present a case of renal infarction associated with pulmonary vein stump thrombosis after a left pneumonectomy, which was treated successfully with edoxaban. Case presentation A 73-year-old man was diagnosed with squamous cell lung cancer (cT1miN0M0 stage IA1). Due to pneumoconiosis, extensive lymph node infiltration into the pulmonary artery was noted and necessitated an open thoracotomy. Ultimately, a left pneumonectomy was performed. Atrial fibrillation occurred on postoperative day 3, and the patient complained of left-sided abdominal pain. Contrast-enhanced computed tomography revealed a left upper pulmonary vein thrombosis and a left renal infarction. Anticoagulant therapy was immediately initiated with heparin and warfarin. On postoperative day 13, warfarin was replaced with the direct oral anticoagulant edoxaban since the patient’s compliance and drug response to warfarin were poor. On postoperative day 19, contrast-enhanced computed tomography revealed a reduction in pulmonary vein stump thrombosis and improvement in renal infarction. Subsequently, the patient was discharged. Three months post-surgery, no infarct lesions or reduced renal function was observed on imaging. Conclusions The direct oral anticoagulant edoxaban could be effective in preventing recurrence or exacerbation of pulmonary vein thrombosis associated with renal infarction without bleeding complications.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disorder of the arterial wall muscular layer which can lead to arterial stenosis, occlusion, and dissection. Clinical presentations of FMD vary depending on the arterial territories involved, often leading to diagnostic challenges. This case report describes an exceptionally unusual presentation of FMD, not previously described, affecting a previously fit and well 37-year-old female presenting with bilateral renal infarction, sequential vertebral artery dissections, mesenteric ischaemia, and the requirement for continued renal replacement. This report highlights how unusual presentations of FMD can mask the underlying diagnosis. Early consideration of FMD in a differential diagnosis can guide an effective management strategy, including appropriate imaging and multi-speciality involvement.

Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.

Renal infarction is an underdiagnosed condition with multiple possible causes, including atrial fibrillation. The treatment approach includes percutaneous endovascular therapy (PET) to restore blood flow, antiplatelet therapy, anticoagulation, or combination therapy, depending on the patient's status and available modalities. Warfarin is the standard anticoagulation therapy, although direct oral anticoagulation (DOAC) therapy is getting more popular. Here, we present a 60‐year‐old male patient with hyperthyroidism complicated by acute renal infarction, which was successfully treated with dabigatran, evident by non‐recurrence and restoration of blood flow in a follow‐up CT angiogram. This case report may open the door for the use of DOAC in acute renal infarction though more studies are needed to prove the efficacy. [ABSTRACT FROM AUTHOR]

Background: Thrombosis of the pulmonary vein stump is a common complication after a left upper lobectomy and can be a source of embolism in various organs, such as the kidneys. A renal infarction, on the other hand, is a rare and often lethal condition that is usually diagnosed postmortem. Here, we present a case of renal infarction associated with pulmonary vein stump thrombosis after a left pneumonectomy, which was treated successfully with edoxaban. Case presentation: A 73-year-old man was diagnosed with squamous cell lung cancer (cT1miN0M0 stage IA1). Due to pneumoconiosis, extensive lymph node infiltration into the pulmonary artery was noted and necessitated an open thoracotomy. Ultimately, a left pneumonectomy was performed. Atrial fibrillation occurred on postoperative day 3, and the patient complained of left-sided abdominal pain. Contrast-enhanced computed tomography revealed a left upper pulmonary vein thrombosis and a left renal infarction. Anticoagulant therapy was immediately initiated with heparin and warfarin. On postoperative day 13, warfarin was replaced with the direct oral anticoagulant edoxaban since the patient's compliance and drug response to warfarin were poor. On postoperative day 19, contrast-enhanced computed tomography revealed a reduction in pulmonary vein stump thrombosis and improvement in renal infarction. Subsequently, the patient was discharged. Three months post-surgery, no infarct lesions or reduced renal function was observed on imaging. Conclusions: The direct oral anticoagulant edoxaban could be effective in preventing recurrence or exacerbation of pulmonary vein thrombosis associated with renal infarction without bleeding complications. [ABSTRACT FROM AUTHOR]

We report the case of 39-year-old Caucasian man presenting in emergency department with new onset of severe hypertension with hypokalaemia eight weeks after renal colic. Patient was referred to a hypertension unit for further investigation. Hormonal analysis confirmed secondary aldosteronism and slightly impaired kidney function. Imaging revealed smaller right kidney, ‘string of beads appearance’ of distal part of right renal artery, a short zone of dissection and renal infarction. Renal scintigraphy showed significant blood flow reduction and severe functional damage of the right kidney. Despite multidrug antihypertensive treatment patient's hypertension was resistant and target organ damage evolved. After initial patient's refusal, he was later successfully treated with laparoscopic simple nephrectomy. Histopathological analysis confirmed renal artery dissection and medial fibroplasia. Thereafter, hypertension was controlled with trandalopril monotherapy. This is a first case report of the patient with renovascular multifocal fibromuscular dysplasia, dissection and renal infarction whose diagnosis of the disease was confirmed by angiography and histopathologic analysis. Resistant hypertension was successfully treated with nephrectomy.

Abstract Renal infarction is an underdiagnosed condition with multiple possible causes, including atrial fibrillation. The treatment approach includes percutaneous endovascular therapy (PET) to restore blood flow, antiplatelet therapy, anticoagulation, or combination therapy, depending on the patient's status and available modalities. Warfarin is the standard anticoagulation therapy, although direct oral anticoagulation (DOAC) therapy is getting more popular. Here, we present a 60‐year‐old male patient with hyperthyroidism complicated by acute renal infarction, which was successfully treated with dabigatran, evident by non‐recurrence and restoration of blood flow in a follow‐up CT angiogram. This case report may open the door for the use of DOAC in acute renal infarction though more studies are needed to prove the efficacy.

Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low. Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, she developed sudden onset of left-sided weakness. Electrocardiogram was normal sinus rhythm. Computed tomography scan of the abdomen showed acute pancreatitis with partial impingement of superior mesenteric vein. Conclusion: Imaging s showed cholelithiasis without evidence of cholecystitis and lower pole right renal infarct likely secondary to obstruction of the right lower renal artery due to calcified plaques at their origin from the aorta. Subsequently, the patient was kept on antiplatelets and planned for discharge uneventfully.

COVID-19 infection has been associated with thrombotic complications, especially venous thromboembolism. Although arterial thrombotic complications are rarely seen in these patients, we report the case of a 43-year-old patient who developed thrombosis of the main branch of the left renal artery, causing partial infarction of the left kidney associated with severe pain. He had no risk factors for thrombosis except for COVID-19 infection. We excluded any possible condition usually associated with renal artery thrombosis/embolism (i.e., cardiovascular, oncological, hematological, or rheumatic). The thrombosis resolved after a combination of anticoagulant and anti-platelet therapy. This case highlights the importance of the risk of recurrence of thrombosis in patients with a recent history of COVID-19, even after hospital discharge, improvement of the initial thrombotic event, and clearance of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disorder of the arterial wall muscular layer which can lead to arterial stenosis, occlusion, and dissection. Clinical presentations of FMD vary depending on the arterial territories involved, often leading to diagnostic challenges. This case report describes an exceptionally unusual presentation of FMD, not previously described, affecting a previously fit and well 37-year-old female presenting with bilateral renal infarction, sequential vertebral artery dissections, mesenteric ischaemia, and the requirement for continued renal replacement. This report highlights how unusual presentations of FMD can mask the underlying diagnosis. Early consideration of FMD in a differential diagnosis can guide an effective management strategy, including appropriate imaging and multi-speciality involvement. [ABSTRACT FROM AUTHOR]

Abstract Background The use of human intravenous immunoglobulin gamma (IVIG) is associated with thromboembolic events as a complication. There are few reported cases of renal infarction during IVIG use in the general population, but transplant kidney may be more susceptible to thromboembolic events following IVIG use. Case presentation A 41-year-old woman visited with fever and pain at the transplant kidney. Six years ago, she underwent kidney transplantation from a deceased donor. Laboratory and radiologic findings were compatible to septic condition, secondary to acute pyelonephritis. We started antibiotics, inotropics, and IVIG. The patient abruptly developed gross hematuria and urine output decreased to 100 cc/day during IVIG administration. Renal doppler and pathologic findings revealed renal infarction. Oliguria and azotemia persisted and she is undergoing maintenance hemodialysis. Conclusion Our case shows that infarction of transplant kidney can be caused by IVIG use in a patient with severe infection. Thus, when using IVIG for kidney transplant patients with high risk of thromboembolic events, we may be careful to prevent the thromboembolic events.

Background: Renal infarction is an extremely rare disease. Although more than 95% of cases are symptomatic, there have been no previously reported asymptomatic cases, without any abnormal blood and urine test findings. Furthermore, the efficacy of long-term treatment of idiopathic renal infarction remains unknown. Case Presentation: A 63-year-old Japanese male underwent laparoscopy; a very low anterior resection of the rectum for lower rectal cancer (stage II) four years and five months prior to diagnosis with renal infarction. During the follow-up imaging studies, asymptomatic idiopathic renal infarction was found incidentally. The blood and urine test findings were normal. Contrast-enhanced computed tomography revealed a linearly bordered area of poor contrast in the dorsal region of the right kidney; however, no renal artery lesions, thromboembolic disease, or coagulation abnormalities were observed. Initial treatment with rivaroxaban 15 mg/day resulted in the remission of the infarcted lesion. The anticoagulation therapy was terminated after about 18 months without any incidences of re-infarction or bleeding events. Conclusions: We reported a very rare case of asymptomatic idiopathic renal infarction where blood and urine tests revealed no abnormal findings, and it was diagnosed incidentally during a post-treatment follow-up examination for lower rectal cancer. Long-term anticoagulant therapy for idiopathic renal infarction should be terminated at an appropriate time, taking the risk of bleeding into account.

Purpose: The association between COVID-19 and hypercoagulability is well established. This is a case of a patient with systemic lupus erythematosus (SLE) who developed unilateral renal vein thrombosis following COVID-19, the third case described in the international literature so far. Methods: Clinical, laboratory characteristics and outcomes of the patient were described in detail. Literature review was performed on MEDLINE database via Pubmed. Search items included COVID-19, renal infarction, and renal thrombosis. A total of fifty-three cases were located. Of these, only two patients had renal vein thrombosis but none of them carried a diagnosis of SLE. However, six cases have been published so far involving SLE patients in whom thromboembolic events developed following COVID-19, but none of them experienced renal vein thrombosis. Conclusion: The present case adds a new piece to the emerging puzzle of COVID-19 associated hypercoagulability, especially among patients with autoimmune diseases.

A 76-year-old man presented with shortness of breath, fever, and fatigue with confirmed COVID-19 by positive RT-PCR test for the SARS-COV-2. Abdominal and pelvis computed tomography with intravenous contrast was performed several days later given the patient’s severe abdominal pain which showed both renal and splenic infarcts despite the use of a proper thromboprophylaxis with subcutaneous heparin, and therefore, therapeutic anticoagulation was initiated. In the course of hospitalization, he developed acute kidney injury, uremic syndrome, and myocardial infarction as well. The patient was treated with fibrinolytic therapy and was eventually discharged on a direct oral anticoagulant.

Spontaneous renal artery thrombosis is a rare medical emergency. The signs and symptoms of the disease are variable and non specific making it difficult to diagnose on time and easily missed for other more common pathologies. Proper evaluation and timely intervention can prevent the loss of renal function. We present a case of 45 year old male with no comorbidity who presented with complaints of right flank pain, fever and vomiting for one day. With physical examination within normal limits, evaluation revealed right renal artery thrombosis.

Regarding the pathophysiology of renal infarction (RI), cardioembolic causes could have large proportion. However, there are notable variations in prevalence of atrial fibrillation (AF) among patients with RI across different studies, ranging from 17 to 65%. The primary objective of this study is to analyze the incidence of AF in patients with RI. This nationwide retrospective cohort study enrolled 5200 patients with RI from the Korean National Institute of Health Services database spanning the years 2013 to 2019. The study accessed the AF incidence rate within 12 months in patients without a prior history of AF. Events occurring within 3 months of RI diagnosis were excluded to mitigate cases diagnosed during the initial screening or those with AF diagnoses that were potentially overlooked in the past. AF occurred in 19.1% of patients with RI over the entire period (median: 2.5 years, interquartile range 1.04–4.25 years). The majority of AF cases (16.1%) occured within the first year, resulting in an overall incidence rate of 7.0 per 100 person-years. Patients with newly developed AF were, on average, older than those who did not develop AF (64.1 vs. 57.3 years, P < 0.001). The independent predictors of AF were identified as age, male sex, higher body mass index, current smoking, ischemic heart disease, and heart failure. Physicians should consider the implementation of active rhythm monitoring for patients with RI to identify potential occurrence of subclinical AF, even if not initially diagnosed during the initial screening after RI diagnosis. • Atrial fibrillation (AF) occurs 19.1% in patients with renal infarction (RI). • Most AF cases are diagnosed within one year of RI diagnosis. • Risk factors include older age, male, high BMI, ischemic disease, and heart failure. • Need for awareness and proactive efforts to find subclinical AF in RI patients. [ABSTRACT FROM AUTHOR]

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Abstract Thrombotic complications in patients with prior COVID‐19 infection raises concern for a persistent hypercoagulable state among these patients. Thus, there is a dire need for further research aimed at anticoagulation guidelines for the same.

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.

We report the case of 39-year-old Caucasian man presenting in emergency department with new onset of severe hypertension with hypokalaemia eight weeks after renal colic. Patient was referred to a hypertension unit for further investigation. Hormonal analysis confirmed secondary aldosteronism and slightly impaired kidney function. Imaging revealed smaller right kidney, 'string of beads appearance' of distal part of right renal artery, a short zone of dissection and renal infarction. Renal scintigraphy showed significant blood flow reduction and severe functional damage of the right kidney. Despite multidrug antihypertensive treatment patient's hypertension was resistant and target organ damage evolved. After initial patient's refusal, he was later successfully treated with laparoscopic simple nephrectomy. Histopathological analysis confirmed renal artery dissection and medial fibroplasia. Thereafter, hypertension was controlled with trandalopril monotherapy. This is a first case report of the patient with renovascular multifocal fibromuscular dysplasia, dissection and renal infarction whose diagnosis of the disease was confirmed by angiography and histopathologic analysis. Resistant hypertension was successfully treated with nephrectomy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We recommend testing for SARS‐CoV‐2 in a patient with an unexplained thromboembolic event, even in the absence of fever or respiratory symptoms. [ABSTRACT FROM AUTHOR]

Resumen: La displasia fibromuscular es una enfermedad no inflamatoria y no aterosclerótica, que puede afectar cualquier lecho arterial; sin embargo, las arterias renales y la carótida interna son las más comprometidas. Se presenta el caso de un paciente que cursó con dolor abdominal y cefalea hemicraneana posterior, con síndrome de Horner incompleto. En arteriografía renal y panangiografía cerebral realizada por Cardiología intervencionista se observó infarto renal derecho y disección de la carótida interna derecha con formación de pseudoaneurisma. Se hizo terapia endovascular con angioplastia y se dio de alta con antiagregación dual.Es importante conocer este tipo de presentación clínica ya que el diagnóstico podría confundirse con otras enfermedades que generan signos y síntomas similares; por consiguiente, es ideal tener sospecha clínica alta para evitar retrasos en el manejo. Abstract: Fibromuscular dysplasia is a non-inflammatory and non-atherosclerotic disease that can affect any arterial bed, with the renal and the internal carotid arteries being the most compromised.A case is presented on a patient that had abdominal pain and pain in the back of the head, and an incomplete Horner syndrome. In the renal arteriography and cerebral pan-angiography carried out by interventionist Cardiology, a right renal infarction and dissection of the right internal carotid was observed with a pseudo-aneurysm formation. Intravenous treatment was performed with angioplasty, and the patient was discharged with dual antiplatelet therapy.It is important to be aware of this type of clinical presentation, since the diagnosis can be confused with other diseases that produce similar signs and symptoms. It would be ideal to have a high clinical suspicion in order to avoid delays in the management.

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.

Renal infarction is a rare pathology, with a serious threat to the functional prognosis of the kidney. Because of its nonspecific clinic presentation, renal infarction is often misdiagnosed as renal colic and pyelonephritis or any etiology of abdominal pain. Embolic Renal infarction occurs commonly in a patient with the risk factors of thromboembolic with heart diseases especially atrial fibrillation. It's important to be aware of this condition to initiate treatment to increase the chance of renal salvage.We report a patient with a renal infarction due to the emboli from left ventricular thrombus with a brief review of the literature.

Background: There is limited evidence on the etiology and outcomes of renal infarction. A provoking factor is identified only in one- to two-thirds of patients. Methods: This is a retrospective observational study. The clinical characteristics and outcomes of patients with acute renal infarction were studied; the sample was divided into two groups according to the presence of at least one provoking factor at the time of diagnosis (atrial fibrillation, flutter, major thrombophilia, or renal artery malformations). Results: The study comprised 59 patients with a mean age of 63 (±16.7) years and a follow-up period of 3.1 (±2.8) years. An identifiable provoking factor was found for 59.3% of the renal infarctions at the time of diagnosis, and atrial fibrillation was the most frequent one (in 49.2% of all patients). Renal impairment was found in 49.2% of the patients at diagnosis and in 50.8% of the patients 6 months after the event (p = 0.525). When compared with the idiopathic group, the patients with provoked infarction were older (69.8 vs. 57.9 years, p = 0.014) and had a higher rate of recurrence of arterial thrombosis during follow-up (18.8 vs. 0%, p = 0.028), but there were no differences in the rest of the baseline characteristics or in mortality rates. Six patients (10.2%) in the idiopathic group were diagnosed with atrial fibrillation during follow-up. Conclusions: Atrial fibrillation, both at diagnosis and at follow-up, is the most common identifiable cause of renal infarction; however, a significant number of patients are idiopathic, and these are younger, but they have a similar burden of cardiovascular disease and a lower risk of arterial recurrence.

Abstract We recommend testing for SARS‐CoV‐2 in a patient with an unexplained thromboembolic event, even in the absence of fever or respiratory symptoms.

Background: The use of human intravenous immunoglobulin gamma (IVIG) is associated with thromboembolic events as a complication. There are few reported cases of renal infarction during IVIG use in the general population, but transplant kidney may be more susceptible to thromboembolic events following IVIG use.Case Presentation: A 41-year-old woman visited with fever and pain at the transplant kidney. Six years ago, she underwent kidney transplantation from a deceased donor. Laboratory and radiologic findings were compatible to septic condition, secondary to acute pyelonephritis. We started antibiotics, inotropics, and IVIG. The patient abruptly developed gross hematuria and urine output decreased to 100 cc/day during IVIG administration. Renal doppler and pathologic findings revealed renal infarction. Oliguria and azotemia persisted and she is undergoing maintenance hemodialysis.Conclusion: Our case shows that infarction of transplant kidney can be caused by IVIG use in a patient with severe infection. Thus, when using IVIG for kidney transplant patients with high risk of thromboembolic events, we may be careful to prevent the thromboembolic events. [ABSTRACT FROM AUTHOR]

BACKGROUND: Renal infarction is a rare disease in clinical practice, in most cases it is triggered by predisposing thromboembolic factors, with atrial fibrillation being the main risk factor, only a minority of cases is associated with small vessel vasculitis and another large percentage is idiopathic. Semiologically it presents with severe, sudden low back pain that simulates reno-ureteral colic; this clinical presentation obligates to rule out urolithiasis, so the diagnosis is usually late and by exclusion. The diagnostic study of choice is the contrast computed axial tomography of abdomen. The basis of treatment is anticoagulation, mainly with coumarins. CLINICAL CASE: A 41-year-old male patient, without risk factors, previously healthy, who debuted with sudden intense left lumbar pain, the diagnosis was made with contrasted abdominal tomography and it was determined that the etiology of the renal infarction was finally idiopathic after ruling out atrial fibrillation, thrombophilia and vasculitis. CONCLUSIONS: More studies are needed to provide guidelines in the treatment of this idiopathic percentage of patients. [ABSTRACT FROM AUTHOR]

Although respiratory symptoms dominate the clinical presentation of COVID-19, atypical, misleading nonpulmonary complaints can occur. Here we present a case of an otherwise healthy 28-year-old cisgender woman whose initial presentation of COVID-19 was unexplained acute abdominal pain, which was later found to be due to renal infarction. She was treated with anti-coagulation and was discharged after a short hospital stay. This case demonstrates the heterogeneous presentations that are associated with COVID-19. Medical providers must be aware that this virus may mimic a diverse array of disorders, even in the absence of respiratory symptoms. [ABSTRACT FROM AUTHOR]

Renal arterial infarction can present with hematuria, proteinuria, and hypertension, features often linked to glomerular disease. An aortic aneurysm is an extraordinarily rare complication of coarctation of the aorta. Acute renal infarction caused by emboli from the aortic aneurysm is a possible complication that has not been reported. We herein report a 10-year-old boy who presented with hematuria, proteinuria, hypertension, and skin rashes on both lower extremities mimicking acute glomerulonephritis but actually resulting from acute renal infarction caused by a coarcted aneurysm-associated thrombus. He was successfully treated with surgical excision of the coarcted aorta and aneurysm followed by subcutaneous low molecular weight heparin without recurrence.

Fibromuscular dysplasia (FMD) is a vascular disease characterized by abnormal arterial wall architecture, usually visualized angiographically as the classic “string of beads” sign. We present the diagnostic dilemma of a 51-year-old woman admitted for a spontaneous renal infarct, with initial examination and investigations equivocal. She was consequently assessed for thromboembolic and vasculitic disease, before proceeding to digital subtraction angiography (DSA). This invasive method elucidated an area of focal FMD, previously not seen on computed tomography angiography (CTA). This is unusual due to CTA's high sensitivity and specificity but could be attributed to the less common subtype of FMD which requires combined imaging modalities to arrive at a diagnosis. Hence, there may be a role for the dual use of CTA and DSA in young patients presenting with a spontaneous renal infarct in the absence of other diagnoses.

COVID-19 infection has been associated with thrombotic complications, especially venous thromboembolism. Although arterial thrombotic complications are rarely seen in these patients, we report the case of a 43-year-old patient who developed thrombosis of the main branch of the left renal artery, causing partial infarction of the left kidney associated with severe pain. He had no risk factors for thrombosis except for COVID-19 infection. We excluded any possible condition usually associated with renal artery thrombosis/embolism (i.e., cardiovascular, oncological, hematological, or rheumatic). The thrombosis resolved after a combination of anticoagulant and anti-platelet therapy. This case highlights the importance of the risk of recurrence of thrombosis in patients with a recent history of COVID-19, even after hospital discharge, improvement of the initial thrombotic event, and clearance of SARS-CoV-2 infection.

Introduction: Primary cardiac tumours are very rare neoplasms, usually with a late diagnosis in clinical practice, because of nonspecific symptoms and clinical signs. Case presentation: We report the case of a 28-year-old woman, who presented for right flank and right iliac fossa pain, radiating to the right lower limb. The pain was progressive and had had its onset 3-4 days previously. The patient was known with renal calyceal microlithiasis (with renal colic in the history) and mild iron deficiency anaemia, and had a medical history of recurrent miscarriages. Physical examination revealed: sinus bradycardia (50-54 bpm), low-grade fever, and positive Giordano sign on the right side. The pain was considered as right renal colic and analgesics and antispasmodics were administered. Blood tests revealed normocytic, hypochromic anaemia and a mild inflammatory syndrome. Abdominal ultrasound revealed bilateral renal microlithiasis and also a triangular, hypoechoic area in the right kidney parenchyma, with no colour Doppler ultrasound signals. Echocardiography revealed a left atrial mass with a diameter of 1.5 cm, hyperechoic, heterogeneous, mobile, attached to the interatrial septum. Chest-abdomen-pelvis CT confirmed the presence of the cardiac mass, as well as an area of right renal infarction. Anticoagulant therapy with low molecular weight heparin was initiated. The patient was referred to the cardiovascular surgery department, where the cardiac mass was removed and sent for histological examination, which confirmed the diagnosis of left atrial myxoma. The patient had a favourable evolution. Conclusions: The presence of sinus bradycardia in a young patient, without known cardiac diseases, led to the necessity of an echocardiography, which revealed the left atrial mass. Peripheral embolization with right kidney infarction represented the clinical onset of the cardiac tumour. In this patient, who presented with abdominal and right flank pain, the previous known diagnosis of renal microlithiasis was initially misleading. Cardiac tumours have unspecific symptoms and the first manifestations could be due to the embolization of tumour fragments in the periphery, mimicking, thus, other disorders.

Thrombotic complications in patients with prior COVID‐19 infection raises concern for a persistent hypercoagulable state among these patients. Thus, there is a dire need for further research aimed at anticoagulation guidelines for the same. [ABSTRACT FROM AUTHOR]