What is the treatment for renal (kidney) infarction?

From the Guidelines

Treatment for renal infarction typically involves selective angioembolization or percutaneous revascularization with stent or stent-graft in hemodynamically stable patients.

Indications for Angioembolization

• Arterial contrast extravasation on CT-scan in hemodynamically stable or transient responder patients 1
• Gross non-self-limiting hematuria 1
• Pseudoaneurysm (PSA) or arteriovenous fistula 1
• Extended perirenal hematoma or progressive decrease in hemoglobin concentration during non-operative management (NOM) 1

Procedure

• Angioembolization should be performed as selectively as possible to limit parenchymal infarction 1
• Agents used for angioembolization can induce either temporary or permanent arterial occlusion, with coils and gelfoam being commonly used 1
• Percutaneous revascularization with stents has shown better outcomes on renal function compared to surgical treatment 1

Patient Selection

• Hemodynamically stable or stabilized patients with severe renal trauma and limited warm ischemia time (<240 min) may benefit from angioembolization and/or percutaneous revascularization 1
• Patients with solitary kidney and moderate to severe renal trauma may be considered for angiography with eventual super-selective angioembolization as the first choice 1
• In cases of failure of initial angioembolization, repeat angioembolization may be considered 1

Contraindications

• Renal venous pedicle avulsion is a contraindication for non-operative management (NOM) and angioembolization, requiring immediate surgery 1

From the Research

Treatment Options for Renal Infarction

The treatment for renal infarction can vary depending on the cause and severity of the condition. Some of the treatment options include:

• Catheter-directed thrombolysis (CDT) 2: This is a minimally invasive procedure that involves injecting a clot-dissolving medication directly into the blocked renal artery to restore blood flow to the kidney.
• Anticoagulation therapy 3, 4, 5: This involves using medications such as heparin, warfarin, or apixaban to prevent further clotting and reduce the risk of another infarction.
• Antiplatelet agents 4: These medications, such as aspirin, can help prevent blood clots from forming and reduce the risk of another infarction.
• Surgical treatment 6: In some cases, surgical intervention may be necessary to remove the blockage and restore blood flow to the kidney. However, this is typically only effective if performed within the first few hours of the infarction.

Outcomes and Prognosis

The outcomes and prognosis for renal infarction can vary depending on the severity of the condition and the effectiveness of treatment. Some possible outcomes include:

• Complete or partial resolution of the thrombus 2
• Decreased kidney function or size 2, 5
• Acute kidney injury (AKI) 4
• New-onset estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² 4
• End-stage renal disease (ESRD) 4, 5
• Mortality 4

Diagnostic Challenges

Renal infarction can be difficult to diagnose, especially in the early stages. Some of the diagnostic challenges include:

• Non-specific clinical manifestations 3, 6
• Complexity of differential diagnosis 3
• Delayed verification of the diagnosis 6
• Limited diagnostic workup in the inpatient setting 3