Appendix
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Nephrology

Renal Infarction

Renal infarction is a rare ischemic event caused by the complete or partial occlusion of the main renal artery or its segmental branches, ultimately leading to ischemic renal necrosis. Renal infarction most commonly occurs due to an embolus originating from the heart or an in situ thrombosis. The diagnosis of renal infarction should be considered in patients who develop sudden abdominal or flank pain with reduced renal function, elevated LDH, hematuria, or proteinuria and who do not have urolith

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • The diagnosis of renal infarction should be considered in patients who develop sudden abdominal or flank pain with reduced renal function, elevated LDH, hematuria, or proteinuria and who do not have urolithiasis or any other diagnosable explanation for their symptoms.
  • Early diagnosis is essential for initiating revascularization therapy promptly, which optimizes renal function recovery.
  • A renal infarction should be suspected whenever a patient presents with acute flank pain and hematuria without evidence of a UTI, hydronephrosis, or urinary calculi.
  • Rapid diagnosis allows for possible immediate catheter-directed thrombolysis therapy, the optimal recommended treatment, ideally administered within 6 hours of the infarction.
  • The triad of sudden abdominal or flank pain, elevated lactate dehydrogenase (LDH), and hematuria and proteinuria suggest renal infarction.
  • Laboratory findings in renal infarction include leukocytosis, elevated C-reactive protein (CRP), very high LDH, macroscopic or microscopic hematuria, and proteinuria.
  • Evaluation often starts with a noncontrast abdominal computed tomography (CT) scan, progressing to a contrast-enhanced study if the original CT scan is negative.
  • If a noncontrast CT is not diagnostic, a contrast-enhanced abdominal CT should be performed to look for renal infarction.
  • Renal CT arteriography is the gold standard investigation for renal infarction and makes the definitive diagnosis, allowing for proper treatment decision-making.
  • Cardiac studies, including an ECG or Holter monitoring, should evaluate for atrial fibrillation in all patients diagnosed with renal infarction without an apparent cause.
  • Catheter-directed thrombolysis, or percutaneous endovascular therapy, is used to revascularize proximal or bilateral renal artery occlusions and restore perfusion in a solitary kidney.
  • Treatment options include intravascular thrombolysis, systemic thrombolysis, anticoagulation, and antiplatelet therapy.
  • Antihypertensive medications inhibiting the renin-angiotensin axis are preferred for renovascular hypertension, which often develops in the first week after a renal infarction due to increased renin levels.
urokinase
intraarterial
Adult
250,000 IU
Renal
Not specified in source
Duration
Not specified in source
heparin
Intravenous
Adult
Not specified in source
Renal
Not specified in source
Duration
Not specified in source
warfarin
Not specified in source
Adult
target INR of 2 to 3
Renal
Not specified in source
Duration
Not specified in source
aspirin
Not specified in source
Adult
Not specified in source
Renal
Not specified in source
Duration
3 to 6 months
clopidogrel
Not specified in source
Adult
Not specified in source
Renal
Not specified in source
Duration
3 to 6 months
  • Systemic thrombolysis can be attempted if catheter-directed thrombolysis is not available.
  • Anticoagulation or antiplatelet agents are considered the treatment of choice for patients who present several days or longer after a renal infarction, as revascularization therapy is not likely to be beneficial.
  • Long-term anticoagulation is initiated for those with underlying hypercoagulation disorders or cardioembolic disease.
  • Open surgery is mostly attempted in the event of trauma-related renal artery injury and aortic dissection extending into the renal artery.
  • Clinicians should refer patients with underlying fibromuscular dysplasia to specialists for possible percutaneous transluminal angioplasty or vascular reconstructive surgery.
  • Atherosclerotic emboli treatment in the renal arteries is primarily supportive.
  • Monitoring patients for complications related to ongoing therapy (eg, bleeding episodes) and regularly checking renal function is reasonable.
  • Lifelong aspirin therapy is typically recommended as well.
  • Follow-up imaging is recommended, and some experts have suggested serial abdominal imaging, preferably with MRI, at 6 and 12 months.
  • Common complications include acute kidney injury, chronic kidney disease, and hypertension.
  • The progression to CKD from AKI correlates with the magnitude of the infarction.
  • Up to 58% of renal infarction patients developed CKD, as detected in follow-up renal scintigraphy.
  • review
    Renal Infarction. StatPearls [Internet] — Jiya Mulayamkuzhiyil Saju, Stephen W. Leslie — StatPearls Publishing, 2024

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov