RENAL EMBOLISM
Posted by admin on July 30th, 2010Renal arterial emboli can occur in any clinical setting that is associated with peripheral embolization (eg, acute myocardial infarction, chronic atrial fibrillation, subacute bacterial endocarditis, and aortic surgery or aortography). The manifestations of renal embolism may vary from essentially no symptoms and signs to a full-blown syndrome of severe flank pain and tenderness, hematuria, hypertension, spiking fevers, markedly reduced renal function, and elevated serum lactic dehydrogenase levels.
Small emboli are difficult to detect, since renal scans show focal perfusion defects in many apparently healthy elderly patients. Major emboli may be suggesled by differential contrast excretion on urography and confirmed by renal scanning and aortography.
Surgery is generally not indicated, and anticoagulant therapy is unlikely to offer major benefit. In many cases in which renal function is discernibly impaired, improvement may occur over a period of several days to weeks.
Renal cholesterol embolization is a specific geriatric syndrome that may occur spontaneously or after aortic surgery or angiography in patients with diffuse atherosclerosis. Definitive diagnosis may be difficult, requiring visualization of cholesterol crystals on renal biopsy; a presumptive diagnosis is often masked by other possible causes of reduced renal function (eg, hypotension or administration of angiographic contrast material). The clinical course varies, with most patients developing progressive renal failure. However, some have only moderate impairment and may regain renal function over time. No specific treatment is available.
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