[Cohort of renal infarction during 2years at Grenoble teaching hospital].

BACKGROUND: Renal infarctions are rare events, clinical symptoms are various and diagnosis may be difficult, leading to diagnosis delay with kidney dysfunction risk.

METHODS: During 24 months (March 2013-February 2015), all patients admitted in nephrology, cardiology, or internal medicine for renal infarction were recorded. Cardiovascular risk, clinic-biologic and radiologic data were recorded. A prospective follow-up at 6 months was offered for each patient.

RESULTS: Eleven patients were admitted from emergency unit and 1 from general practitioner. Clinic symptoms are various: abdominal pain, headache, hypertension, and stroke. Diagnosis was not initially evocated, and was given by CT scan with 3 days median delay. Etiologies were composed of 5 dissections, 4 embolisms (atrial fibrillation), 1 cannabinoid arteritis, 1 thrombosis on atheroma, 1 thrombosis on postradiotherapy stenosis. Initial treatment was anticoagulation alone for 7 patients, with antiplatelet agent for 1 patient, anticoagulation followed by antiplatelet agent for 2 patients, and antiplatelet agent alone for 2 patients. We observed LDH elevation (4 cases on 5 available data) at admission; inflammatory syndrome, hypokalemia, and hypertension at 48-72h of symptoms. At 6months follow-up, one patient had altered glomerular filtration rate, and one patient had recidivism.

CONCLUSION: Delay of diagnosis is a real problem for renal infarction, and need to be evocated every flank pain. LDH elevation may help clinician to suggest renal infarction and lead to CT scan. Association of delayed inflammatory syndrome, hypertension and hypokalemia after flank pain strongly suggest renal infarction.