title: A case series of acute renal infarction at a single center in Japan.
abstract: BACKGROUND
  The prevalence of acute renal infarction (ARI) in Japan remains unclear. We describe the clinical features and renal prognosis of ARI in Japanese patients.
  
  
  METHODS
  This single-center, retrospective, observational study included 33 patients with newly diagnosed ARI (2009-2013). Their clinical features and long-term renal outcomes were evaluated.
  
  
  RESULTS
  The prevalence of ARI among emergency room patients was 0.013 %. The incidence of ARI among in-patients was 0.003 % (mean age 71.9 ± 13.4 years; men 63 %). Enhanced computed tomography or renal isotope scans were obtained to diagnose ARI. ARI involved the left kidney in 70 %, right kidney in 18 %, and both kidneys in 12 % of patients. Four cases had splenic infarction, and 70 % of patients had atrial fibrillation. We noted abdominal or flank pain in 66 %, fever (>37.6 °C) in 36 %, and nausea/vomiting in 6 % of patients. The white blood cell count, and levels of lactate dehydrogenase and C-reactive protein peaked at 2-4 days after onset. Acute kidney injury due to ARI occurred in 76 % of patients. The estimated glomerular filtration rate decreased to ~70 % and recovered to ~80 % of the original value after 1 year. The mortality rates were 9 and 15 % at 1 month and 1 year, respectively.
  
  
  CONCLUSIONS
  We determined the prevalence of ARI among emergency room patients, its incidence among in-patients, and short-term and long-term mortality. The majority of ARI cases were of cardiac origin, and the others were due to trauma or systemic thrombotic disease. Clinicians should recognize ARI as a fatal arterial thrombotic disease.
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan. tasukunagasawa0903@gmail.com.
authors.forename: Tasuku
authors.identifier: http://orcid.org/0000-0002-2012-1171
authors.initials: T
authors.lastname: Nagasawa
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Fukami
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Saito
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Chikamatsu
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichisita Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
authors.forename: Yasumichi
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D004632:Emergency Medical Services; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007238:Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000098:blood supply* / Q000378:metabolism / Q000503:physiopathology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011866:Radioisotope Renography; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase
keywords: Acute kidney injury; Arterial thrombosis; Renal infarction