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Acute renal infarction resulting from fibromuscular dysplasia: a case report.

Saarinen HJ, Palomäki A - J Med Case Rep (2016)

Bottom Line: Further tests confirmed a diagnosis of renal infarction as a result of fibromuscular dysplasia.Contrast-enhanced computer tomography and assay of lactate dehydrogenase are recommended.The optimal treatment is still uncertain.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland. harri.saarinen@fimnet.fi.

ABSTRACT

Background: Acute abdominal pain is one of the most frequent complaints evaluated at emergency departments. Approximately 25 % of abdominal pain patients discharged from emergency departments are diagnosed with undifferentiated abdominal pain. One possible reason for acute abdominal pain is renal infarction. Diagnosis is difficult and often late.

Case presentation: A white, 33-year-old, previously healthy Finnish man came to our emergency department because of acute abdominal pain. After evaluation and follow-up he was discharged the next day with a diagnosis of undifferentiated abdominal pain. He returned a day later and was diagnosed with renal infarction. Appropriate therapy was initiated in the nephrology ward. Further tests confirmed a diagnosis of renal infarction as a result of fibromuscular dysplasia. He recovered well and was discharged on the tenth day of hospitalization. His renal function was normal.

Conclusions: Renal infarction is rare and should be considered if a patient with intense flank pain has no sign of urolithiasis or pyelonephritis. Contrast-enhanced computer tomography and assay of lactate dehydrogenase are recommended. The optimal treatment is still uncertain. Every patient discharged with undifferentiated abdominal pain should be given clear instructions as to when it is necessary to return to the emergency department.

No MeSH data available.


Related in: MedlinePlus

A contrast-enhanced abdominal computed tomography scan performed a day after the first visit reveals a renal infarction of the left kidney
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Fig2: A contrast-enhanced abdominal computed tomography scan performed a day after the first visit reveals a renal infarction of the left kidney

Mentions: Our patient was treated with intravenous oxycodone and his pain was relieved. A helical CT scan showed no sign of urolithiasis and his kidneys were normal (Fig. 1). Laboratory analysis showed an elevated white blood cell (WBC) count of 13.4 × 109/L. However, his serum concentration of C-reactive protein (CRP) was normal, as were other laboratory test results (Table 1). Next morning, our patient was feeling well and had no abdominal pain. His WBC count had decreased to 10.0 × 109/L. Otherwise the results were still normal. Our patient was discharged and advised to return should the pain reoccur. He returned to the ED the next evening because of rapid-onset intense abdominal pain located in the lower left quadrant of his abdomen, radiating to the left testicle. A urologist was consulted because of the possibility of testicular torsion, but our patient's clinical findings did not support this. The provisional diagnosis was still urolithiasis. Owing to the intense pain, explorative surgery was planned in order to assess the testicles and kidneys. Before any definite decision, contrast-enhanced abdominal CT was carried out. This revealed renal infarction of the left kidney (Fig. 2). The renal artery was open. After consultation, our patient was admitted to the nephrology ward.Fig. 1


Acute renal infarction resulting from fibromuscular dysplasia: a case report.

Saarinen HJ, Palomäki A - J Med Case Rep (2016)

A contrast-enhanced abdominal computed tomography scan performed a day after the first visit reveals a renal infarction of the left kidney
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862219&req=5

Fig2: A contrast-enhanced abdominal computed tomography scan performed a day after the first visit reveals a renal infarction of the left kidney
Mentions: Our patient was treated with intravenous oxycodone and his pain was relieved. A helical CT scan showed no sign of urolithiasis and his kidneys were normal (Fig. 1). Laboratory analysis showed an elevated white blood cell (WBC) count of 13.4 × 109/L. However, his serum concentration of C-reactive protein (CRP) was normal, as were other laboratory test results (Table 1). Next morning, our patient was feeling well and had no abdominal pain. His WBC count had decreased to 10.0 × 109/L. Otherwise the results were still normal. Our patient was discharged and advised to return should the pain reoccur. He returned to the ED the next evening because of rapid-onset intense abdominal pain located in the lower left quadrant of his abdomen, radiating to the left testicle. A urologist was consulted because of the possibility of testicular torsion, but our patient's clinical findings did not support this. The provisional diagnosis was still urolithiasis. Owing to the intense pain, explorative surgery was planned in order to assess the testicles and kidneys. Before any definite decision, contrast-enhanced abdominal CT was carried out. This revealed renal infarction of the left kidney (Fig. 2). The renal artery was open. After consultation, our patient was admitted to the nephrology ward.Fig. 1

Bottom Line: Further tests confirmed a diagnosis of renal infarction as a result of fibromuscular dysplasia.Contrast-enhanced computer tomography and assay of lactate dehydrogenase are recommended.The optimal treatment is still uncertain.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland. harri.saarinen@fimnet.fi.

ABSTRACT

Background: Acute abdominal pain is one of the most frequent complaints evaluated at emergency departments. Approximately 25 % of abdominal pain patients discharged from emergency departments are diagnosed with undifferentiated abdominal pain. One possible reason for acute abdominal pain is renal infarction. Diagnosis is difficult and often late.

Case presentation: A white, 33-year-old, previously healthy Finnish man came to our emergency department because of acute abdominal pain. After evaluation and follow-up he was discharged the next day with a diagnosis of undifferentiated abdominal pain. He returned a day later and was diagnosed with renal infarction. Appropriate therapy was initiated in the nephrology ward. Further tests confirmed a diagnosis of renal infarction as a result of fibromuscular dysplasia. He recovered well and was discharged on the tenth day of hospitalization. His renal function was normal.

Conclusions: Renal infarction is rare and should be considered if a patient with intense flank pain has no sign of urolithiasis or pyelonephritis. Contrast-enhanced computer tomography and assay of lactate dehydrogenase are recommended. The optimal treatment is still uncertain. Every patient discharged with undifferentiated abdominal pain should be given clear instructions as to when it is necessary to return to the emergency department.

No MeSH data available.


Related in: MedlinePlus