From the Research
Acute renal infarction treatment requires prompt anticoagulation with intravenous unfractionated heparin or low molecular weight heparin, followed by oral anticoagulation with a direct oral anticoagulant like apixaban, as it has been shown to have a lower risk of bleeding events compared to warfarin 1. The treatment approach should prioritize minimizing the risk of bleeding while effectively preventing further thromboembolic events.
- The initial anticoagulation can be achieved with intravenous unfractionated heparin (initial bolus of 80 units/kg followed by continuous infusion at 18 units/kg/hour, adjusted to maintain aPTT at 1.5-2.5 times normal) or low molecular weight heparin such as enoxaparin (1 mg/kg subcutaneously every 12 hours) 2.
- This should be followed by oral anticoagulation with a direct oral anticoagulant like apixaban (5 mg twice daily) for at least 3-6 months, as it has been shown to be safer than warfarin in terms of bleeding risk in patients with acute kidney injury 1, 3.
- Supportive care includes pain management with opioid analgesics like morphine (4-8 mg IV every 4 hours as needed) and blood pressure control.
- In cases diagnosed within 12-24 hours of symptom onset, endovascular interventions such as intra-arterial thrombolysis with tissue plasminogen activator (tPA) or mechanical thrombectomy may be considered to restore renal perfusion.
- Surgical revascularization is rarely performed but may be necessary in specific cases.
- Patients should be monitored for complications including hypertension, renal dysfunction, and progression to chronic kidney disease.
- The underlying cause of the infarction (such as atrial fibrillation, hypercoagulable states, or arterial dissection) must be identified and treated to prevent recurrence, as initial renal function and previous treatment with oral anticoagulants have been shown to be significant prognostic factors 4.