Ann Rehabil Med.  2013 Aug;37(4):567-571. 10.5535/arm.2013.37.4.567.

Multiorgan With Renal Infarction Following Treatment of Cerebral Infarction

• Kim JH
• Kang C
• Moon HJ
• Joo MC

• KMID: 2266614
• DOI: http://doi.org/10.5535/arm.2013.37.4.567

Abstract

Acute renal infarction is a rare disease and it is often difficult to make a clinical diagnosis due to the non-specific clinical presentations and lack of the physicians' awarenesses. We experienced a case of a 72-year-old man who was diagnosed as multiorgan with renal infarction during the bridge therapy of cerebral infarction with atrial fibrillation. Computed tomogram (CT) with intravenous contrast of the abdomen and pelvis revealed left renal infarction with renal artery occlusion, multifocal splenic infarction, and ischemic colitis on rectum and sigmoid colon. The patient was treated with low molecular weight heparin for 10 days, his symptoms were improved and laboratory findings were normalized. Follow-up CT was performed on the 43th day, there were persisted left renal infarction with atrophic change shown and the splenic perfusion was improved.

Keyword

Renal infarction; Atrial fibrillation; Cerebral infarction

MeSH Terms

Abdomen
Atrial Fibrillation
Awareness
Cerebral Infarction
Colitis, Ischemic
Colon, Sigmoid
Follow-Up Studies
Heparin, Low-Molecular-Weight
Humans
Infarction
Pelvis
Perfusion
Rare Diseases
Rectum
Renal Artery
Splenic Infarction
Heparin, Low-Molecular-Weight

Figure

• 

  Fig. 1 Magnetic resonance images of brain. Diffusion-weighted axial image shows high signal intensity on both lower paramedian pons (arrow).

• 

  Fig. 2 Axial contrast-enhanced computed tomography images of the patient's abdomen and pelvis showed a left renal infarction (A, arrow), splenic infarction (B, arrow), and ischemic colitis (C, arrow).

• 

  Fig. 3 Follow-up contrast-enhanced computed tomography image of the patient's abdomen and pelvis showed a persisted left renal infarction with atrophic change (arrow).

Reference

1. Tsai SH, Chu SJ, Chen SJ, Fan YM, Chang WC, Wu CP, et al. Acute renal infarction: a 10-year experience. Int J Clin Pract. 2007; 61:62–67. PMID: 17229180.

2. Menke J, Luthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. Am J Cardiol. 2010; 105:502–510. PMID: 20152245.

3. Abboud H, Labreuche J, Gongora-Riverra F, Jaramillo A, Duyckaerts C, Steg PG, et al. Prevalence and determinants of subdiaphragmatic visceral infarction in patients with fatal stroke. Stroke. 2007; 38:1442–1446. PMID: 17379822.

4. Korzets Z, Plotkin E, Bernheim J, Zissin R. The clinical spectrum of acute renal infarction. Isr Med Assoc J. 2002; 4:781–784. PMID: 12389340.

5. Kim JS, Lee SY, Kim JH, Kwon EH, Song SH, Lee DW, et al. Acute renal infarction: clinical features in 23 cases. Korean J Med. 2006; 70:543–550.

6. Salih SB, Al Durihim H, Al Jizeeri A, Al Maziad G. Acute renal infarction secondary to atrial fibrillation: mimicking renal stone picture. Saudi J Kidney Dis Transpl. 2006; 17:208–212. PMID: 16903629.

7. Spyropoulos AC, Turpie AG, Dunn AS, Spandorfer J, Douketis J, Jacobson A, et al. Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost. 2006; 4:1246–1252. PMID: 16706967.

8. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285:2864–2870. PMID: 11401607.

9. Hazanov N, Somin M, Attali M, Beilinson N, Thaler M, Mouallem M, et al. Acute renal embolism: forty-four cases of renal infarction in patients with atrial fibrillation. Medicine (Baltimore). 2004; 83:292–299. PMID: 15342973.

10. Norman RA Jr, Galloway PG, Dzielak DJ, Huang M. Mechanisms of partial renal infarct hypertension. J Hypertens. 1988; 6:397–403. PMID: 3385205.