Infarto Renal Agudo
TUTOR: DR. CALANDRELLI, MATIAS
PRESENTAN: DR. VICARIO DIEGO
DR. CHIOCCONI LUIS
Caso Problema: Hombre de 47 años con abdomen
agudo
Enfermedad Actual: Paciente de 47 años ingresa
por guardia por dolor abdominal difuso de 48
horas de evolución, que se intensifica en las
últimas horas en flanco izquierdo, intensidad
10/10, dolor tipo lacerante.
Dolor que no cede con AINES.
Afebril, sin náuseas ni vómitos.
Antecedentes Personales:
HTA diagnosticada hace 9 años (abandonó
edicación)
Tabaquista de 42 p/y
Consumidor de marihuana actualmente
Cocaína dejo hace 5 años
Examen Físico:
Signos Vitales: PA: 130/90 mmHg, FC: 100 lpm,
FR: 20 cpm, T: 36 ºC
Abdomen: RHA conservados. Blando, depresible
doloroso a predomino Flanco Izquierdo. No se palpan
visceromegalias.
Miembros: tono, trofismo, fuerza y temperatura
conservados. Pulsos periféricos presentes y
simétricos.
Genitourinario: Diuresis positiva, PPL negativo.
Resto de examen físico sin alteraciones.
Laboratorio
Orina Completa
Normal
Imágenes: TC abdomen y pelvis c/c oral y e.v.
(01/12/2010)
TC Abdomen y Pelvis c/c oral y EV: El riñón izquierdo presenta en el
sector lateral de su tercio medio un segmento que no realza con el
contraste EV.
TC Abdomen c/c EV: InfartoRenal
Infarto renal
ECO Doppler renal: (02/12/2010)
Doppler renal bilateral dentro parámetros normales. Se
evidencia un ligero aumento de la ecogenicidad de un
sector segmentario del parénquima renal de tercio medio
del riñón izquierdo.
ECO Cardiograma: (02/12/2010)
 Hipertrofia concéntrica VI
 Fracción de eyección 58%
 Dilatación leve AI
ECO Cardiograma Transesofagico (02/12/2010)
 Dilatación Ao ascendente, cayado y Ao descendente con
enfermedad ateromatosa grado III
Se descarta fuente cardioembólica.
Evolución: durante la internación el paciente
permanece asintomático, con tendencia a la
hipertensión leve.
Interpretación: Infarto renal de probable etiología
tromboembólica.
Se decide tratamiento con antiagregante plaquetario,
estatinas y antihipertensivos.
Se otorga egreso Sanatorial para continuar estudio
en ambulatorio.
Pendiente: Descartar trombofilias
Indicaciones de egreso:
Dieta hiposódica
Losartan 50 mg / día
AAS 100 mg / día
Atorvastatina 20 mg / día
Tramadol 50 mg / día
Diclofenac 75 mg / día
En consulta ambulatoria, el hematólogo decide
iniciar ACO (RIN 2,18)
Controles de TA: entre 120/70 – 150/100 mmHg
Laboratorio:
Uremia: 27 mg/dl,
Creatinina: 1,20mg/dl
Perfil Lipidico: LDL: 86 HDL: 46, Colesterol: 147
Ac. Urico: 4,8
Trombofilia:
Homocisteinemia: 126
Proteina C reactiva: normal
Proteina S: normal
Anticoagulante Lupico: levemente aumentado
Ac anticardiolipina IgG 19
IgM 25 (elevado)
Proteinograma por electroforesis: normal
El paciente completo 3 meses de terapia ACO
permaneciendo asintomático, con pruebas de
función renal normales y sin evidencias de nuevos
episodios de embolia.
Definición: Infarto Renal
 Es la oclusión de la rama principal o segmentarias de
la/las arterias renales, generando así isquemia y
necrosis.
 Incidencia de 0,007%-1,4%
 2-5% de embolización sistémicas
Hoxie, HJ, Coggin, CB. Renal Infarction: Statistical study of two hundred and five cases and detailed report of an unusual case. Arch
Intern Med 1940; 65:587
Domanovits H, Paulis M, Nikfardjam M, Meron G, K?rkciyan I, Bankier AA, Laggner AN Medicine (Baltimore). 1999;78(6):386-94.
Clínica:
Dolor Abdominal
Puede tener :-Nauseas/ vomitos
-Fiebre
LAB: Leucocitosis, LDH, disfunción renal.
Orina: hematuria (macro y/o microscópica).
Estudios por imágenes: Tc abdomen c/c
Ecodoppler vasos renales
Angiografía Gold standard
Domanovits H, Paulis M, Nikfardjam M, Meron G, K?rkciyan I, Bankier AA, Laggner AN Medicine (Baltimore). 1999;78(6):386-94.
Dx diferenciales
 Colico ureteral
 Pielonefritis
 Traumatismo lumbar
 Isquemia mesenterica
 Colico biliar
 Colecistitis
 Obstruccion urinaria
 Carcinoma Renal
 Diseccion aortica
Causas
•
•
•
•
•
•
•
•
F.A
Estenosis mitral
Antecedente de embolia previa
HTA
Cardiopatia isquemica
Trombofilias
Enf antifosfolipidicas
Cancer
Domanovits H, Paulis M, Nikfardjam M, Meron G, K?rkciyan I, Bankier AA, Laggner AN Medicine (Baltimore). 1999;78(6):386-94.
Tratamiento:
 Fibrinolisis local o sistemica
 Cirugia de revascularizacion (Traumatico, Obst
bilateral o monorreno)
 ACO
 Antiagregacion
Acute renal infarction. Clinical characteristics of 17 patients.
Domanovits H, Paulis M, Nikfardjam M, Meron G, K?rkciyan I, Bankier AA, Laggner AN
Medicine (Baltimore). 1999;78(6):386-94.

We analyzed the medical records of patients with an established diagnosis of acute renal
infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male)
who were admitted to our emergency department between May 1994 and January 1998 were
diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction
(0.007% of all patients). We screened the records of the 17 patients for a history with increased
risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to
be associated with acute renal infarction. A history with increased risk for thromboembolism
with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial
fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9),
and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from
the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum
lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of
17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14
(82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with
the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain,
elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain
onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove
acute renal infarction.
Acute renal embolism. Forty-four cases of renal infarction in patients with atrial
fibrillation.
Hazanov N, Somin M, Attali M, Beilinson N, Thaler M, Mouallem M, Maor Y, Zaks N, Malnick S
Medicine (Baltimore). 2004;83(5):292-9.
Examinaron HC de todos los pacientes admitidos en Kaplan Medical Center
and Sheba Medical Center in central Israel desde el 1984 hasta 2002 que
tuvieron Dx de infarto renal y FA.






Se identificaron 44 casos de embolia renal: 23 mujeres y 21 hombres, con edad
promedio 69.5 +/- 12.6 años
9 pacientes estaban siendo tratados con warfarina, 6 (66%) (INR)<1.8
Con la TC se diagnostico 12/15 cases (80%); ecografia, 3/27 cases (11%). La
Angiografia fue positiva 10/10 casos (100%).
La mortalidad a los 30-dias fue de 11.4%.
La embolia renal se Dx en mayores de 60 años y eventos embolicos previos.
La mayoria que estaba ACO estaba fuera de rango.
Department of Internal Medicine C, Kaplan Medical Center, Rehovot, Israel
Blood pressure and renal outcomes in patients with kidney infarction and
hypertension.
Paris B, Bobrie G, Rossignol P, Le Coz S, Chedid A, Plouin PF
J Hypertens. 2006;24(8):1649-54.

OBJECTIVE: To assess the causes and frequency of kidney infarction associated with hypertension, and the
blood pressure and renal function outcomes. METHODS: We analyzed the records of patients with kidney
infarction documented by angiography and referred to a hypertension unit. RESULTS: Spontaneous kidney
infarction was documented in 55 of 18,287 patients and was associated with renal artery disease in 41 cases.
Twenty-five patients had a longstanding history of hypertension at referral, and 30 patients presented with
acute hypertension. Patients with acute hypertension were more likely to report a history of lumbar pain and
to develop malignant hypertension than patients with longstanding hypertension; they also had higher plasma
renin concentrations. Data for long-term follow-up after referral were available for 36 patients, including 15
patients who underwent surgery or renal artery angioplasty. From referral to most recent follow-up, the blood
pressure decreased from 176/111 to 143/89 mmHg in patients with longstanding hypertension, and from
183/111 to 127/80 mmHg in those with acute hypertension (P = 0.007/0.041 for between-group differences).
Three patients with acute hypertension had normal blood pressure without treatment at follow-up. Patients
with long-term follow-up displayed no change in the glomerular filtration rate. CONCLUSION: Kidney
infarction is a rare cause of hypertension, usually associated with renal artery lesions. In cases of kidney
infarction with acute hypertension, the blood pressure outcome is favorable following intervention and/or
medication, and hypertension may resolve spontaneously.
Gracias
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Infarto Renal Agudo