Kamran Khan, MD
Dr.
Icahn School of Medical School at Mount Sinai, United States
Disclosure information not submitted.
Goutham Talluri, MD
Dr.
North central Bronx hospital, United States
Disclosure information not submitted.
Title: A Case of Renal Infarction
Introduction: Renal Infarction is caused most commonly by thrombo-embolic phenomenon (in the setting of atrial fibrillation, after myocardial infarction or plaque disruption), thrombosis or renal artery dissection. We present a case of Renal Infarction in a patient with Ventricular Aneurysm.
Case :34 years old male with past history of Cocaine abuse, Hypertension, Hyperlipidemia and Coronary Artery Disease status post stent placement, Heart Failure with reduced Ejection Fraction (EF 45%) came to the Emergency Department with complaint of sudden onset of severe, non-exertional left quadrant abdomen pain radiating to back and Left lower ribs, aggravated with movements. Physical exam with Left flank tenderness. Labs significant only for Leukocytosis without left shift ( White Cell Count 15300 /cmm), mild transaminitis and urinalysis indicating no hematuria. EKG with no evidence of acute ischemic event. CT abdomen & Pelvis with contrast revealing Left upper kidney with wedge shaped hypoattenuation consistent with new renal infarct, a total of 2 new infarcts beside old infarct & new Left Ventricle Apical aneurysm. Pt received pain medication and therapeutic dose of Low Molecular Weight Heparin. Further workup inpatient for mild transaminitis was unrevealing. Patient’s coagulation workup including Lupus anticoagulant and Anti Nuclear Antibody were unremarkable. Trans-Esophageal Echocardiogram showed small left ventricular apex aneurysm but no thrombus or valvular abnormalities were found. Patient was placed on telemetry with no clear rhythm disorder detected while inpatient, placed Ziopatch on discharge and ultimately planned for implantable loop recorder outpatient. Patient was transitioned to warfarin after bridging before discharge.
Discussion: Renal Infarction in setting of Left Ventricular Apical Aneurysm is a rare entity which presents with non-specific signs and symptoms and with little guidance regarding therapy once the condition is diagnosed. The most common cause for renal infarction is thromboembolic phenomenon in setting of Atrial Fibrillation or Myocardial Infarction. Further workup to detect underlying rhythm disorder with Holter monitor is very important as patients may require anticoagulation to avoid further clots.