Definition

Infarction of the kidney is defined as necrosis (tissue destruction) of ischemic nature (due to a lack of vascularization) of a part of the kidney. This rare condition in Nephrology (medical specialty for the urinary tract) due to occlusion (absence of passage) acute (occurring relatively quickly) a renal artery.

Causes

Most often, a heart condition in the majority of cases (90%), causes the occurrence of renal infarction. Cardiological diseases concerned are (non-exhaustive list):

• Embolism: this occurs (among others) after endocarditis, a myocardial infarction, thrombosis, cardiac valve impairment, the presence of from the aorta or an atherosclerotic plaque catheterization.
• Acute thrombosis, and in particular the migration of parcels of cholesterol from pasted in aortic atherosclerotic plaques. Generally, this type of condition occurs in individuals having surgery of the abdominal aorta. In some cases, this disease is found after an additional examination of type aortagram (direct visualization of the aorta with an x-ray after injection of dye into the blood). In some patients, it is possible to observe what is called crystals embolisés through the examination of fundus oculi.

Symptoms

The individuals of a myocardial infarction of the kidney symptoms the following (non-exhaustive list):

• Back pain in significant myocardial infarction.
• Nausea and vomiting.
• Hyperthermia (fever).
• Elevation of blood pressure.

When it comes to renal infarction in a small area of the kidney, the symptoms are often absent (asymptomatic patient).

Medical analysis

In myocardial infarction of the kidney, there is the presence (non-exhaustive list):

• Proteinuria (presence of albumin in the urine).
• Hematuria (blood in the urine presence).
• An increase in transaminases.
• An increase of the LDH. The elevation of the LDH (the destruction of all body tissues characteristic marker) is the most common defects encountered during blood tests. Values in the LDH, after the first pain, are likely to reach the figures of 800 to 3000 units per litre per 24 hours.
• Of an oligoanurie (decrease in the amount of urine, or even absence of urine). These signs are mainly observed in bilateral renal thrombosis (concerning both kidneys) or single kidney.

The amount of urea and creatinine in the blood is not necessarily high when the other kidney is working properly.

Evolution of the disease

The vascular network of the kidney is particularly dense and rich. This is the reason why the prognosis of myocardial infarction of the kidney is relatively favourable because the kidney is likely to find part or all of its function in the weeks following a heart attack, even if it is extended.

Differential diagnosis

Infarction of the kidney should not be confused with:

• A urinary lithiasis.
• Acute pyelonephritis.
• Acute abdominal disease.

Treatment

The patient should be hospitalized in a service of Nephrology.Implemented treatment includes anticoagulant and thrombolytic agents (drugs) to destroy the blood clot by intra-arterial route.Some medical teams specialized in Nephrology practice transluminal angioplasty or surgery obstruction. This surgery can repair the deformation of vessels or expand or remodel a shrinking vessel. However, this technique presents some risks, primarily in individuals with other vascular conditions or for people with high blood pressure or heart failure. In these individuals, most often it preferred to restrict anticoagulants.