Renal InfarctionRenal blood vessel occlusion results in renal infarction - the formation of a coagulated, necrotic area in one or both kidneys. The location and size of the infarction depend on the site of vascular occlusion. Most commonly, infarction affects the renal cortex but it can extend into the medulla. Residual renal function after infarction depends on the extent of the damage from the infarction.
Most common caused - renal artery embolism secondary to mitral stenosis. Other causes includes infective endocarditis, atrial fibrillation, microthrombi in the left ventricle, rheumatic valvular disease, or recent myocardial infarction.
Signs and symptoms
Renovascular hypertension, a frequent complication that may occur several days after infarction, results from reduced blood flow, which stimulates the renin-angiotensin mechanism.
A history of predisposing cardiovascular disease or other factors in a patient with typical clinical features strongly suggests renal infarction. A firm diagnosis requires the appropriate laboratory tests:
Infection in the infarcted area or significant hypertension may require surgical repair of the occlusion or nephrectomy. Surgery to establish collateral circulation to the area can relieve renovascular hypertension.
Persistent hypertension may respond to antihypertensives and a low-sodium diet. Additional treatments may include administration of intra-arterial streptokinase, lysis of blood clots, catheter embolectomy, and heparin therapy.
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