J Lipid Atheroscler.  2016 Jun;5(1):93-97. 10.12997/jla.2016.5.1.93.

A Case of Bilateral Renal Infarction of Unknown Cause in a Previously Healthy Young Male

• Choi HJ
• Jeong H
• Choi HM
• Oh DJ

• KMID: 2328842
• DOI: http://doi.org/10.12997/jla.2016.5.1.93

Abstract

We report a rare case of bilateral renal infarction resulting in acute renal failure in a previously healthy 26-year-old soldier. The patient presented with an abdominal pain and bilateral costovertebral angle tenderness. Laboratory studies showed elevated serum creatinine, mild leukocytosis, and increased lactate dehydrogenase. Contrast-enhanced computed tomography showed multiple perfusion defects in both kidneys with wedge-shaped infarction in right kidney. Kidney biopsy performed in the left kidney revealed microinfarction. Comprehensive work-up did not reveal any specific causes or risk factors except smoking, and the infarction was considered to be idiopathic. He emphasized that he received extremely strenuous military training several days before he came to the hospital. He was treated with low molecular weight heparin with significant improvement in renal function. Further studies are needed for the characterization of idiopathic renal infarction in previously healthy individuals and evaluating the mechanisms including strenuous physical activity on the renal blood flow.

Keyword

Bilateral renal infarction; Acute renal failure; Idiopathic

MeSH Terms

Abdominal Pain
Acute Kidney Injury
Adult
Biopsy
Creatinine
Heparin, Low-Molecular-Weight
Humans
Infarction*
Kidney
L-Lactate Dehydrogenase
Leukocytosis
Male*
Military Personnel
Motor Activity
Perfusion
Renal Circulation
Risk Factors
Smoke
Smoking
Creatinine
Heparin, Low-Molecular-Weight
L-Lactate Dehydrogenase
Smoke

Figure

• 

  Fig. 1 Contrast-enhanced abdominal computed tomography (CT). (A) Arterial phase, (B) Delayed phase, CT demonstrated mild enlargement, multiple perfusion defects and delayed contrast excretion in bilateral kidneys with unequivocal wedge-shaped infarction in right kidney.

• 

  Fig. 2 Renal biopsy findings. (A) Light microscopy (×10). In the renal cortex, patch microinfarction is shown with loss of nuclei and ballooning degeneration of tubular epithelial cells (not shown). In the medulla, severe interstitial hemorrhage is also shown, (B) Transmission electron microscopy (TEM) (×5000). Ultrastructurely, glomerular cells, particularly podocytes, exhibit severe necrosis, entirely detached from the glomerular basement membrane.

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