Bilateral Renal Infarction Associated With Left Renal Artery Thrombosis and Predominant Left Renal Infarction: A Case...

Although uncommon, bilateral renal infarction and renal artery thrombosis should be considered a potential cause of acute kidney injury. Its nonspecific presentation frequently contributes to delayed diagnosis, thereby compromising timely intervention and increasing the risk of irreversible injury. While embolic and thrombotic mechanisms are the predominant etiologies, idiopathic renal artery thrombosis is rare. We report the case of a 42-year-old man who presented with sudden-onset left flank pain radiating to the left upper quadrant, associated with nausea and abdominal discomfort. He had a history of tuberculosis diagnosed seven months earlier and had completed a six-month course of anti-tuberculous therapy with isoniazid, rifampin, pyrazinamide, and ethambutol. He had no history of cardiovascular disease, thrombophilia, or autoimmune disorders. Laboratory results revealed a mild elevation in serum creatinine (1.5 mg/dL), with no prior baseline for comparison. Urinalysis was unremarkable. Unexplained flank pain in association with elevated serum creatinine and lactate dehydrogenase raised clinical suspicion for renal vascular pathology. Contrast-enhanced computed tomography of the abdomen and pelvis revealed extensive thrombosis involving the left renal artery, resulting in total left kidney infarction. In addition, a small segmental infarction was seen in the mid pole of the right kidney posteriorly; however, the majority of the right kidney parenchyma is intact and enhancing. The right main renal artery was patent. A vascular surgeon was consulted, who, because of the delayed presentation, recommended conservative management rather than surgical intervention. At the time of presentation, the patient was initially treated with systemic therapeutic anticoagulation. Following clinical stabilization, anticoagulation was transitioned to oral rivaroxaban for continued anticoagulant therapy. Renal function and clinical symptoms progressively improved.