Treatment options for acute renal infarction

Robert Grubišić-Čabo, Filip Grubišić-Čabo,

General hospital Šibenik

Renal infarction is a rare disease (1). The major causes of renal infarction include atrial fibrillation and renal artery injury. The optimal treatment for renal infarction due to thromboemboli, in situ thrombosis, or renal artery dissection is uncertain, given the absence of comparative studies. Reported approaches include anticoagulation, endovascular therapy ( thrombolysis/ thrombectomy with or without angioplasty), and open surgery. For patients with acute renal artery occlusion that is diagnosed early ( eg, less than one to two days from symptom onset) and in selected patients with persistent hypertension, percutaneous endovascular therapy is suggested, unless contraindication exist. Anticoagulation is clearly indicated when warranted by the underlying disease ( eg, atrial fibrillation, left ventricular thrombus, or a hypercoagulable state), but not in a number of other settings, such as tumor or fat embolisation or aortic dissection. The primary aim of anticoagulation is to prevent future events. There seems to be little indication for primary surgical therapy in the current era, particularly in patients with two functioning kidneys and unilateral disease. A possible exception is the trauma patient in whom surgery is indicated for other reasons.

1) Bourgault M, Grimbert P, Verret C, et al. Acute renal infarction: a case series. Clin J Am Soc Nephrol 2013; 8:392.