From the Research
Confirming a renal infarct requires a combination of clinical assessment, laboratory tests, and imaging studies, with the most direct approach being a contrast-enhanced CT scan of the abdomen and pelvis, as recommended by the most recent study 1. The diagnosis of renal infarction should be suspected in patients presenting with sudden-onset flank pain, particularly those with risk factors such as atrial fibrillation, hypercoagulable states, or recent vascular procedures. Some key points to consider in the diagnosis of renal infarction include:
- Laboratory tests should include urinalysis, complete blood count, comprehensive metabolic panel, lactate dehydrogenase (LDH), and C-reactive protein (CRP), with elevated LDH levels being particularly suggestive of renal infarction 2.
- For patients with suspected embolic causes, an echocardiogram and electrocardiogram should be performed to identify cardiac sources.
- In some cases, renal angiography may be necessary for definitive diagnosis, especially when considering interventional treatment.
- The use of contrast-enhanced CT scans is generally recommended, but the risk of contrast-induced nephropathy should be considered, especially in patients with chronic kidney disease 3.
- Renal MRI with contrast can provide similar information with greater detail but may be less readily available 1. The most recent and highest quality study 1 suggests that MRI can provide an expanded role in acute abdominal and pelvic imaging, including the diagnosis of renal infarction, due to its superior soft-tissue contrast and high sensitivity. Therefore, the most appropriate diagnostic approach for renal infarction is a contrast-enhanced CT scan or MRI, combined with laboratory tests and clinical assessment, as supported by the most recent evidence 1.