title: Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation.
abstract: Acute renal embolus is rarely reported in the medical literature; thus, accurate data regarding presentation, laboratory tests, diagnostic techniques, and treatment are lacking. To better define this condition, we examined the medical records of all patients admitted to Kaplan Medical Center and Sheba Medical Center in central Israel from 1984 to 2002 who had a diagnosis of renal infarction and atrial fibrillation. We noted demographic, clinical, and laboratory parameters; method of diagnosis; treatment received; and patient outcome. We identified 44 cases of renal embolus: 23 females and 21 males, with an average age of 69.5 +/- 12.6 years. Thirty (68%) patients had abdominal pain, and 6 (14%) had a previous embolic event. Nine patients were being treated with warfarin on admission, 6 (66%) of whom had an international normalized ratio (INR) < 1.8. Hematuria was present in 21/39 (54%), and 41 (93%) patients had a serum lactate dehydrogenase (LDH) level > 400 U/dL. The mean LDH was 1100 +/- 985 U/dL. Diagnostic techniques included renal isotope scan, which was abnormal in 36/37 cases (97%); contrast-enhanced computed tomography (CT) scan, which was diagnostic in 12/15 cases (80%); and ultrasound, which was positive in only 3/27 cases (11%). Angiography was positive in 10/10 cases (100%). Twenty-three (61%) of 38 patients had normal renal function on follow-up. The 30-day mortality was 11.4%. Renal embolus was diagnosed mainly in patients aged more than 60 years, some of whom had a previous embolic event. Most of those receiving anticoagulant therapy had a subtherapeutic INR. Abdominal pain was common, as well as hematuria and an elevated LDH. These patients are at risk of subsequent embolic events to other organs. The most sensitive diagnostic technique in this population is a renal isotope scan, but contrast-enhanced CT scan requires further assessment.
authors.affiliation: From Department of Internal Medicine C (NH, MS, MA, NB, SM), Kaplan Medical Center, Rehovot; and Department of Internal Medicine D (MT), Department of Internal Medicine E (MM), Department of Internal Medicine A (YM), and Department of Internal Medicine F (NZ), Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Natasha
authors.initials: N
authors.lastname: Hazanov
authors.forename: Marina
authors.initials: M
authors.lastname: Somin
authors.forename: Malka
authors.initials: M
authors.lastname: Attali
authors.forename: Nick
authors.initials: N
authors.lastname: Beilinson
authors.forename: Michael
authors.initials: M
authors.lastname: Thaler
authors.forename: Meir
authors.initials: M
authors.lastname: Mouallem
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.forename: Nurit
authors.initials: N
authors.lastname: Zaks
authors.forename: Stephen
authors.initials: S
authors.lastname: Malnick
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007238:Infarction / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019934:International Normalized Ratio; D007557:Israel; D007668:Kidney / Q000098:blood supply* / Q000378:metabolism / Q000503:physiopathology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012078:Renal Artery Obstruction / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D012079:Renal Circulation / Q000502:physiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014508:Urea / Q000097:blood; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D014859:Warfarin; D014508:Urea; D003404:Creatinine; D007770:L-Lactate Dehydrogenase