[A case of heterochronic bilateral renal infarction]

A 57-year-old man was admitted with aching pain in his left frank. Left renal infarction was revealed by CT scan and arteriogram. Intra-arterial thrombolytic therapy was performed, and resulted in a recanalization of the occluded artery and elimination of frank pain, but residual stenosis was recognized. At 27 hours after the onset of left renal infarction, in spite of the systemic anti-coagulant and thrombolytic therapy to prevent the recurrence of the thrombosis, right renal infarction occurred. Immediate intra-arterial thrombolytic therapy for right renal infarction was performed successfully. Subsequently the serum creatinine level increased from 0.8-0.9 to 1.2-1.3 mg/dl due to the functional loss of the left kidney, which was confirmed by follow-up renoscintigraphy. Conservative intra-arterial thrombolytic therapy seems to be the most effective treatment for renal infarction, but left renal salvage failed due to the prolonged time of occlusion and residual stenosis. Also, catheterization for diagnosis and therapy or thrombolytic therapy itself may induce an additional infarction.