Renal Infarction

A rare condition, more common in older patients with atherosclerosis/thromboembolism risk factors.

Presentation

Small infarcts are often asymptomatic, found incidentally on imaging. Larger infarcts present with acute flank pain, haematuria and proteinuria.

Causes

• Thromboembolism — the most common cause (cardiac valve, ventricular or arterial thrombus, aorta)
• Aortic dissection
• Renal artery dissection
• Iatrogenic (e.g. angiography)
• Vasculitis
• Malignant hypertension
• Renal vein occlusion (very rare; may occur in infancy from severe dehydration)

Examination

Urine dipstick, ECG (looking for AF), blood pressure.

Investigations

Best seen on CT intravenous pyelogram; CT angiography may be needed to identify the site of occlusion.

Management

Determine the underlying cause. If complete renal artery occlusion is present, revascularisation can be attempted, though results are often disappointing.