Specialty for Patient to See for Renal Infarction
Patients with renal infarction should be referred to a nephrologist for specialized evaluation and management. 1
Primary Care Management and Referral Indications
- Renal infarction is a rare condition resulting from acute disruption of renal blood flow, often presenting with flank pain, hematuria, elevated lactate dehydrogenase (LDH), and leukocytosis 2, 3
- Initial evaluation may occur in primary care or emergency settings, but specialty care is essential for proper management 1
- The condition can lead to significant complications including acute kidney injury (occurring in ~20% of cases), chronic kidney disease, and rarely end-stage renal disease 4
Why Nephrology is the Appropriate Specialty
- Nephrologists are specifically trained to manage conditions affecting kidney blood flow and parenchyma 1
- They can provide comprehensive assessment of kidney function and implement appropriate treatment strategies to preserve remaining kidney function 1
- Many nephrologists are trained in diagnostic and interventional nephrology procedures that may be needed for evaluation and management 5
Timing of Nephrology Referral
- Immediate nephrology consultation is warranted when renal infarction is diagnosed or strongly suspected 1
- Guidelines recommend nephrology referral for any abrupt sustained fall in GFR, which commonly occurs with renal infarction 1
- Prompt referral is associated with better outcomes and may help prevent progression to chronic kidney disease 1
Additional Specialists That May Be Involved
- Vascular specialists or interventional radiologists may be consulted if renal artery lesions (found in ~81% of renal infarction cases) require intervention 6
- Cardiologists may need to be involved for patients with cardiogenic causes (which account for ~56% of renal infarction cases) 4, 6
- Hematologists may be consulted in cases related to hypercoagulable states (approximately 7% of cases) 4
Long-term Follow-up
- Ongoing nephrology care is essential as approximately 11% of patients develop new-onset reduced kidney function (eGFR <60 mL/min/1.73m²) following renal infarction 4
- Nephrologists can coordinate multidisciplinary care when needed for complex cases 1
- For patients who develop chronic kidney disease as a result of renal infarction, nephrology follow-up is recommended to monitor and manage complications 1
Special Considerations
- For patients with renal infarction who develop cardiorenal syndrome, joint care between nephrology and cardiology is optimal 1
- In cases of renal infarction during pregnancy, a maternal-fetal medicine specialist should be consulted in addition to nephrology 1
- For patients with diabetic kidney disease who develop renal infarction, nephrology referral is particularly important to manage the complex interplay between conditions 1