From the Research
The treatment of kidney infarction requires prompt diagnosis and management to preserve renal function, and anticoagulation with direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban is recommended over warfarin due to their lower bleeding rates and similar efficacy in preventing stroke and systemic embolism, as shown in a recent study 1. The initial workup should include laboratory tests, such as complete blood count, comprehensive metabolic panel, lactate dehydrogenase, and urinalysis, as well as imaging studies like contrast-enhanced CT or MRI to evaluate the extent of the infarction and identify underlying causes like atrial fibrillation, hypercoagulable states, or arterial dissection. Treatment begins with anticoagulation using intravenous unfractionated heparin or low molecular weight heparin, followed by oral anticoagulation with DOACs like apixaban (5 mg twice daily) or rivaroxaban (20 mg daily with food) for at least 3-6 months, as supported by a systematic review and meta-analysis 2. Pain management with opioid or non-opioid analgesics and blood pressure control are essential supportive measures, and for cases diagnosed within 12-24 hours of symptom onset with large infarcts, endovascular interventions like intra-arterial thrombolysis or mechanical thrombectomy may be considered. Some key points to consider in the treatment of kidney infarction include:
- The use of DOACs over warfarin due to their lower bleeding rates and similar efficacy in preventing stroke and systemic embolism 1
- The importance of prompt diagnosis and management to preserve renal function
- The need for close monitoring of renal function, electrolytes, and blood pressure during treatment
- The consideration of endovascular interventions for cases diagnosed within 12-24 hours of symptom onset with large infarcts
- The use of pain management and blood pressure control as supportive measures It is also important to note that the treatment of kidney infarction should be individualized based on the patient's specific needs and underlying conditions, and that the use of DOACs should be guided by the patient's renal function and other factors, as highlighted in a study on the efficacy and safety of DOACs in patients with chronic kidney disease 3.