Acute renal infarction: Clinical characteristics and prognostic factors

Abstract

Introduction: Acute renal infarction (ARI) is an uncommon disease, whose real incidence is probably higher than expected. It is associated with poor prognosis in a high percentage of cases. Objectives: To describe the main clinical, biochemical and radiologic features and to determine which factors are associated with poor prognosis (death or permanent renal injury). Materials and methods: The following is a retrospective, observational, single-center study. All patients diagnosed with ARI by contrast-enhanced computed tomography (CT) over an 18-year period were included. Patients were classified according to the cardiac or non-cardiac origin of their disease. Clinical, biochemical and radiologic features were analysed, and multiple logistic regression model was used to determine factors associated with poor prognosis. Results: A total of 62 patients were included, 30 of which had a cardiac origin. Other 32 patients with non-cardiac ARI were younger, had less comorbidity, and were less frequently treated with oral anticoagulants. CT scans estimated mean injury extension at 35%, with no differences observed between groups. A total of 38% of patients had an unfavourable outcome, and the main determinants were: Initial renal function (OR = 0.949; CI 95% 0.918–0.980; p = 0.002), and previous treatment with oral anticoagulants (OR = 0.135; CI 95% 0.032–0.565; p = 0.006). Conclusions: ARI is a rare clinical condition with non-specific symptoms, and it is not associated with cardiological disease or arrhythmias in more than half of cases. A substantial proportion of patients have unfavourable outcomes, and the initial renal function is one of the main prognostic factors.

Keywords

• Oral anticoagulation
• Atrial fibrillation
• Renal embolism
• Acute renal infarction
• Acute renal failure