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Abstract:

BACKGROUND The 2 largest clinical series to date, each including 17 patients, suggest that renal infarction (RI) is an infrequent disorder typically developing in the setting of cardiac disease, notably atrial fi brillation. HYPOTHESIS The expanding use of computed tomography (CT) in patients with acute abdomen may change the spectrum of RI by enabling the detection of focal abnormalities in renal parenchymal perfusion. METHODS This study population includes 22 consecutive patients presenting at a single university hospital from August 2002 to September 2004 with symptomatic non-traumatic non-iatrogenic RI confi rmed with contrast enhanced CT. Patients were stratifi ed according to the presence or absence of known or obvious cardiac disease processes. RESULTS Nine of the 22 patients (41%) had known or obvious cardiac disease at presentation, invariably including atrial fi brillation. In 13 patients (59%), no cardiac disease was apparent at presentation nor detected subsequently. This ‘non-cardiac’ group was younger (50 years of age (range 44-54), median (interquartile range) versus 77 years (range 59-84), p = 0.01). Smoking (8 of 13 patients (62%)), was the predominant traditional risk factor. Other possible contributing factors included oral contraceptive use in 3, and combined hyperhomocysteinemia and antithrombin defi ciency, protein S defi ciency, factor V Leiden, and arterial dissection in 1 each. RI was often not suspected before CT revealed the diagnosis. CONCLUSION RI may occur in previously apparently healthy individuals of middle age. The diagnosis should not be overlooked even in the absence of obvious risk factors for thromboembolism. Further studies should focus on the scope of etiological investigation and on appropriate therapeutic management strategies.