Acute Renal Infarction Heralds New-Onset Paroxysmal Atrial Fibrillation

Acute renal infarcts may be asymptomatic or occur with flank pain, nausea, vomiting, or hematuria. Given the non-specific symptomatology, many acute renal infarcts are misdiagnosed or not diagnosed at all. Most are diagnosed with contrast-enhanced computed tomography. A high index of suspicion should be maintained, especially for patients with cardiovascular risk factors. A negative workup for the etiology of a renal infarction should prompt cardiac monitoring for paroxysmal atrial fibrillation because this is the primary etiology in up to one-third of cases. Treatment of atrial fibrillation reduces the risk of recurrent renal infarction as well as stroke. Early diagnosis of acute renal infarction in a select group of patients may allow for endovascular intervention to re-establish vascular patency. Here, we review the case of a 43-year-old man with no significant medical history who presented with flank pain in the setting of an acute renal infarct.