AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2641-0419/190
1* Senior Consultant & Coordinator, Department of Clinical & Interventional Cardiology, Evercare Hospitals Dhaka, Bangladesh.
2 Senior Registrar, Department of Clinical & Interventional Cardiology, Evercare Hospitals Dhaka, Bangladesh.
3 Registrar, Department of Clinical & Interventional Cardiology, Evercare Hospitals Dhaka, Bangladesh
*Corresponding Author: A Q M Reza, Senior Consultant, Department of Clinical & Interventional Cardiology, Evercare Hospitals Dhaka, Bangladesh.
Citation: A.Q.M Reza, Atique Bin Siddique, Poppy Bala, Mohammad Ziaur Rahman, Mahmood Hasan Khan, (2021) Percutaneous Intervention in Acute Renal Attack. J. Clinical Cardiology and Cardiovascular Interventions, 4(13); Doi:10.31579/2641-0419/190
Copyright: © 2021 A Q M Reza, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 30 June 2021 | Accepted: 12 July 2021 | Published: 16 July 2021
Keywords: renal infarction; renal artery thrombosis; renal impairment
A young patient with renal infarction presented with right lower abdominal pain due to renal artery thrombosis is a rare clinical condition that warrants epidemiologic, clinical, angiographic, and prognostic importance. The patient’s condition was acute and was featured with abdominal pain, leukocytosis, and minimal renal impairment.
The case presented here enabled us to widened our vision with patients presented with abdominal pain should warrant clinical suspicion about renal infarction although this is a rare clinical entity.
Renal infarction (RI) is an uncommon condition resulting from a sudden disruption of blood flow in the renal artery. RI is frequently misdiagnosed or diagnosed late because of its rarity and nonspecific clinical presentation, which may result in irreversible damage to the renal parenchyma or an increase in the risk of other embolic events affecting other organs. The prevalence of RI has been estimated from autopsy studies at 14 per 1000 [1]. Recent studies based on admissions to the emergency department have reported estimated incidences of 0.004%–0.007% [1,2]. Many etiologic factors are known to favor the occurrence of RI, but atrial fibrillation (AF) is currently considered the most important risk factor for this condition. AF was recently identified as the main causal factor in 64% of published cases of RI [3], and an incidence of renal thromboembolism of 2% was reported in a series of almost 30,000 patients with AF followed for up to 13 years [4]. Other risk factors for RI include valvular or ischemic heart disease, endocarditis, hyper coagulation disorders, hematologic disease, and spontaneous renal artery dissection, reflecting the multiplicity of underlying causal mechanisms. However, despite extensive investigations, the cause of RI remains undetermined in some cases. Renal infarct affects elderly patients, with an average age of 67 with neither gender nor predominance side predominance. Patients generally complain of flank pain and/or upper abdominal pain which are often associated with nausea and vomiting. Occasionally, patients may have hematuria. Fever is also common and was present in about half of the reported cases. Blood pressure may be acutely elevated, and this is presumed to be through a renin-mediated mechanism. Signs of extra renal embolism may also be present. In contrast, renal infarct may be completely asymptomatic and then diagnosed incidentally as a result of abdominal CT examination5. Here we will report a rare case where a young patient without any risk factors presented with lower abdominal and back pain due to acute renal infarct and successfully managed quickly by percutaneous renal artery thrombus extraction followed by stenting.
This 41-year-old normotensive, non-diabetic, nonsmoker Bangladeshi gentleman presented to the emergency department with 12 hours history of lower abdominal pain and back pain. He was admitted to an outside hospital 10 hours prior to our Emergency unit, where no obvious cause of pain was sought out there. On arrival his BP was 110/80 mm Hg, Pulse 80/min, body temperature 36.6-degree C. USG whole abdomen done outside hospital showed no abnormality. In our Emergency unit CT scan whole abdomen with contrast done, advised by general surgeon suspecting acute abdomen which revealed no definite etiology. They found a large wedge shaped area of infarct in the anterior cortex of the right kidney measuring maximum 6.2 cm in largest dimension (Figure 1). Both kidneys are normal in position, size & contour, there are two renal arteries seen on the right side. The main renal artery is arising at L1 vertebral level at 10 O’clock position. The main renal artery showed slightly irregular outline and ill-defined irregular filling defect approximately 3 cm distal to its origin suggestive of intraluminal thrombus. From emergency unit urgent cardiology consultation was requested which was arranged immediately. Immediately ECG & echocardiography were done, which revealed no significant abnormality. Neither past nor present cardiac issue was found. Abdominal CT showed normal abdominal Aorta. No source of thrombo - embolism was found. After discussion with patient party and with their full consent it was decided to take the patient to cath lab for immediate renal angiography.
Renal angiography showed right renal artery thrombosis (Figure 2). So we decided to aspirate the thrombus with suction catheter. After suction tight stenosis was noticed just before the bifurcation of the main renal artery. We crossed the lesion with a floppy wire and gradually dilated the lesion with 2.0 mm X 15 mm and 4.5 mm X 10 mm balloons successively. A dissection was noticed just 3 cm after the origin of right renal artery.
So we decided to put two stents. Distal segment was stented with 6.0 mm X 18 mm and a 7.0 mm X 18 mm stent was given overlapping & covering proximal to that, covering the dissection. Final angiogram showed right renal artery was well dilated with good distal flow and patient’s pain almost subsided immediately (Figure 3).To find out the cause behind the acute thrombosis, patient was evaluated for anti-phospholipid syndrome, protein C & S deficiency and hyperlipidemia which all came negative. Patient was discharged after 4 days with pain free and stable condition.
Blood Chemistry:
Follow-up Investigations:
The patient was followed up. The follow-up investigation profile after 03 months:
Renal infarct is typically caused by blood or cholesterol clots occluding the renal artery or branch vessels. The source of blood clots, typically, is from atrial fibrillation causing thrombogenesis in the left atrium and left atrial appendage. Cholesterol-based emboli cause partial occlusions with a more chronic presentation. In a study of over 600 patients with peripheral arterial thromboembolism, the most common site of peripheral arterial thromboembolism was the extremities (61%), followed by the mesenteric arteries (29%), the pelvic arteries (9%), the aorta (7%) and, followed last, by the renal arteries (2%) [4]. In a case series of 27 patients, 41% had obvious cardiac disease, almost all with atrial fibrillation; however, 59% had no discernible structural or arrhythmic cardiac disease [8]. Idiopathic patients are typically younger [8] and have a paucity of thrombogenic risk factors [9].
Complete infarct (involving entire kidney due to occlusion or interruption of the renal artery) is the rarest, seen typically after trauma or interventions involving the aorta [11]. Most kidney infarction results from emboli caused by atrial fibrillation or endocarditis11 causing only partial occlusion of the renal artery or a branch. Rare causes reported include spontaneous renal artery dissection [12], dilated cardiomyopathy [13], paradoxical embolism [14,15] and involved multiple organs. Bilateral infarction has also been reported7 including bilateral (global) renal infarction subsequent to dissecting aneurysms of the aorta [16] with septic emboli from endocarditis, lupus vasculitis or with sickle cell disease [17] or fibro- muscular dysplasia of the renal arteries [18,19]. Reports of other causes associated with renal infarction include trauma, vasculitis, instrumentation, transplant, sepsis [17], sickle cell disease [20] and anti-phospholipid antibody syndrome [21,22] cocaine use [23] and subsequent to carotid artery dissection [24]. In our case there were no risk factors.
The most common complaints at presentation are flank pain [7] or abdominal pain [25], usually constant in nature [5]. Other common features include fever [7,8], nausea and vomiting [7,8,25]. Lumbar and flank tenderness [8] are seen and are even more likely in the idiopathic/younger group. Oliguria is rarely found [25]. New-onset hypertension is uncommon, but can be seen especially if there are underlying renal artery lesions [11].
The typical patient tends to be older, with an average age of 67 in one series [7], although significant portions are younger. Reviewing 89 cases from the literature [2,7,25,26] the mean age at presentation was 65.7 years, with no significant gender predominance or right or left kidney predominance. About 10% of the cases presented with bilateral renal involvement. Previous thromboembolic events in 20/89 (22%) were observed.
Urinalysis is recommended, with hematuria being a very common finding, seen in all cases in one study [7]. However, hematuria is not universal, with about one-half of the patients in another study showing no hematuria [25], and two cases from another center also with no hematuria [27]. In contrast, elevations of lactate dehydrogenase (LDH) are almost universal, with nearly all patients in one study [8] and in all cases in other reports [3,27]. Proteinuria was seen in 45% of the patients in one retrospective case review [25]. The white blood cell count was often elevated [3,8]. Serum creatinine was not markedly elevated at presentation, but a small increase was seen [8] at peak in one study and a more marked elevation was seen in another slightly larger case review [25]. C-reactive protein is also often elevated [8].
Because of the infrequent nature of this malady, no large prospective studies have evaluated the optimal treatment modalities regarding the dosing of heparin, the use of low molecular weight heparin or thrombolytics or using medical management vs. surgical management. At this time, there are only recommendations based on the consensus in the literature.
The most common sequel to renal infarction is loss of renal function and persistent hypertension [11]. However, many patients go on to have normal kidney function [7,11,25] with no permanent hypertension. A small percent will need dialysis, 8% in one case series [25].
Repeat embolic events have been observed, some with events prior to the renal infarct and some with subsequent events [25]. Because of the lack of prospective study data, it is unknown what the benefit of continuing anticoagulation would be. However, given data regarding other catastrophic thrombotic events, it is likely recommended to continue indefinitely in the setting of atrial fibrillation.
Renal infarction is an extremely rare clinical condition. Sharing the knowledge of its epidemiologic, clinical, angiographic, and prognostic features are noteworthy. We report such a rare clinical entity with its successful interventional treatment not only to notify the clinicians but also for identification of such cases clinically, diagnose it in early phase and treat it successfully. As it is an extreme rare clinical scenario it was a challenge for us. We took the challenge and overcome it successfully with full recovery of the patient. So, for the clinicians we should be aware of such rare conditions & their epidemiologic, clinical, angiographic features and treat these cases in time and save the vital organs of human body as well as serve the humanity.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
