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Multifocal Renal Infarction and Diabetic Ketoacidosis: Diagnostic Challenges and Anticoagulation Management in a
Levi Miles1, Brandon Shin1, Hyein Ji2
1School of Medicine, Loma Linda University, Loma Linda, CA, USA.
The American Journal of Case Reports
|October 26, 2024
Summary
This case highlights idiopathic renal infarction in an acutely ill patient. Prompt diagnosis and anticoagulation are crucial for managing renal artery thrombosis, even when the cause is unclear.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Incidental renal infarcts secondary to thrombosis pose diagnostic challenges in acutely ill patients.
- Idiopathic renal infarction requires thorough workup and management strategies.
- Understanding renal artery thrombosis is critical for patient outcomes.
Observation:
- A 68-year-old woman presented with abdominal pain, diabetic ketoacidosis, and pyelonephritis.
- Computed tomography revealed multifocal right kidney infarcts and proximal right renal artery thrombus.
- Further workup for hypercoagulable states and echocardiogram were largely unremarkable.
Findings:
- The patient was diagnosed with idiopathic renal infarction and right renal artery thrombus.
- Treatment included anticoagulation with enoxaparin, transitioned to apixaban.
- Multidisciplinary evaluation recommended against surgical intervention.
Implications:
- This case underscores the diagnostic difficulties of incidental renal thrombosis in hospitalized patients.
- Therapeutic anticoagulation is the standard treatment for renal artery thrombosis, irrespective of the underlying cause.
- Further research into the etiology and optimal management of renal infarctions is warranted.
