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      Acute Renal Infarction With Heritable Coagulopathy and Patent Foramen Ovale

      case-report
      Author(s): , MD 1 , , D.O. 2
      Publication date (Electronic):
      Journal: Radiology Case Reports
      Publisher: Elsevier
      Keywords: CT, computed tomography, MRI, magnetic resonance imaging

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          Abstract

          We present the case of a 27-year-old woman who presented to the emergency department with the acute onset of left sided abdominal pain. Initial CT examination showed multiple renal infarcts in the lower pole of the left kidney, and an angiogram showed thrombus in a segmental branch of the left renal artery. Subsequent transesophageal echocardiogram demonstrated a small patent foramen ovale with bidirectional shunting, and serum coagulopathy evaluation demonstrated a G20210A prothrombin gene mutation. We conclude that the renal infarctions were caused by a paradoxical embolic event in the setting of an inherited coagulopathy and a patent foramen ovale.

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          Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation.

          N Zaks, Yasmin Maor, Malka Attali … (2004)
          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) 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. Copyright 2004 Lippincott Williams & Wilkins
          Article 0 comments Cited 51 times – based on 0 reviews     Review now
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            Acute renal infarction. Clinical characteristics of 17 patients.

            G Meron, M Nikfardjam, A Laggner … (1999)
            We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.
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              Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review.

              Brian D Quinlan, J W Eikelboom, Stephen Ho … (2006)
              The 2 most common genetic polymorphisms that predispose to a first episode of venous thromboembolism (VTE) are factor V Leiden (FVL) and prothrombin G20210A. However, the effect of these polymorphisms on the risk of recurrent VTE is unclear. We performed a meta-analysis to obtain best estimates of the relative risk of recurrent VTE associated with these genetic polymorphisms. Electronic and manual searches were used to identify cohort studies of patients with a first episode of VTE that reported the incidence of objectively confirmed recurrence following discontinuation of anticoagulation among those with or without heterozygous FVL or prothrombin G20210A polymorphism. Thirteen reports fulfilled our criteria for inclusion. Pooled results from 10 studies involving 3104 patients with first-ever VTE revealed that FVL was present in 21.4% of patients (95% confidence interval [CI], 20%-23%) and associated with an increased odds of recurrent VTE of 1.41 (95% CI, 1.14-1.75; P = .08 for heterogeneity). Pooled results from 9 studies involving 2903 patients with first-ever VTE revealed that prothrombin G20210A was present in 9.7% of patients (95% CI, 9%-11%) and associated with an increased odds of recurrent VTE of 1.72 (95% CI, 1.27-2.31; P = .19). The estimated population-attributable risk of recurrence for FVL was 9.0% (95% CI, 4.5%-13.2%) and for prothrombin G20210A was 6.7% (95% CI, 3.4%-9.9%). Heterozygous FVL and prothrombin G20210A are each associated with a significantly increased risk of recurrent VTE after a first event, but the magnitude of the increase in risk is modest and by itself is unlikely to merit extended-duration anticoagulation. These data call into question the cost-effectiveness of routine testing for these common inherited thrombophilic polymorphisms among patients with a first episode of VTE.
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                Author and article information

                Contributors
                Eric M. Vilbert
                Stefan V. Franciosa
                Journal
                Journal ID (nlm-ta): Radiol Case Rep
                Journal ID (iso-abbrev): Radiol Case Rep
                Title: Radiology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 1930-0433
                Publication date PMC-release: 07 December 2015
                Publication date Collection: 2009
                Publication date (Electronic): 07 December 2015
                Volume: 4
                Issue: 1
                Electronic Location Identifier: 260
                Author notes
                [1]

                Eric M. Vilbert, M.D., is in the department of Radiology at the Bryn Mawr Hospital, Main Line Health System, Bryn Mawr, PA, United States of America.

                [2]

                Stefan V. Franciosa, D.O., is in the Department of Interventional Radiology of the Main Line Health System, Bryn Mawr, PA, United States of America.

                Article
                Publisher ID: S1930-0433(15)30547-1 Publisher ID: 260
                DOI: 10.2484/rcr.v4i1.260
                PMC ID: 4897885
                PubMed ID: 27307798
                SO-VID: 6888c412-637a-4d16-92dc-3444c7f4db40
                Copyright © © 2009 The Authors.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Subject: Article

                Keywords: ct, computed tomography,mri, magnetic resonance imaging
                Data availability:
                Keywords: ct, computed tomography, mri, magnetic resonance imaging

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