| Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation. | |
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MedLine Citation:
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PMID: 15342973 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Acute renal embolus is rarely reported in the medical literature; thus, accurate data regarding presentation, laboratory tests, diagnostic techniques, and treatment are lacking. To better define this condition, we examined the medical records of all patients admitted to Kaplan Medical Center and Sheba Medical Center in central Israel from 1984 to 2002 who had a diagnosis of renal infarction and atrial fibrillation. We noted demographic, clinical, and laboratory parameters; method of diagnosis; treatment received; and patient outcome. We identified 44 cases of renal embolus: 23 females and 21 males, with an average age of 69.5 +/- 12.6 years. Thirty (68%) patients had abdominal pain, and 6 (14%) had a previous embolic event. Nine patients were being treated with warfarin on admission, 6 (66%) of whom had an international normalized ratio (INR) < 1.8. Hematuria was present in 21/39 (54%), and 41 (93%) patients had a serum lactate dehydrogenase (LDH) level > 400 U/dL. The mean LDH was 1100 +/- 985 U/dL. Diagnostic techniques included renal isotope scan, which was abnormal in 36/37 cases (97%); contrast-enhanced computed tomography (CT) scan, which was diagnostic in 12/15 cases (80%); and ultrasound, which was positive in only 3/27 cases (11%). Angiography was positive in 10/10 cases (100%). Twenty-three (61%) of 38 patients had normal renal function on follow-up. The 30-day mortality was 11.4%. Renal embolus was diagnosed mainly in patients aged more than 60 years, some of whom had a previous embolic event. Most of those receiving anticoagulant therapy had a subtherapeutic INR. Abdominal pain was common, as well as hematuria and an elevated LDH. These patients are at risk of subsequent embolic events to other organs. The most sensitive diagnostic technique in this population is a renal isotope scan, but contrast-enhanced CT scan requires further assessment. |
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Authors:
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Natasha Hazanov; Marina Somin; Malka Attali; Nick Beilinson; Michael Thaler; Meir Mouallem; Yasmin Maor; Nurit Zaks; Stephen Malnick |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Medicine Volume: 83 ISSN: 0025-7974 ISO Abbreviation: Medicine (Baltimore) Publication Date: 2004 Sep |
Date Detail:
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Created Date: 2004-09-02 Completed Date: 2004-10-12 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 2985248R Medline TA: Medicine (Baltimore) Country: United States |
Other Details:
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Languages: eng Pagination: 292-9 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2004 Lippincott Williams & Wilkins |
Affiliation:
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Department of Internal Medicine C, Kaplan Medical Center, Rehovot, Israel. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aged, 80 and over Anticoagulants / therapeutic use Atrial Fibrillation / complications*, drug therapy, physiopathology Biological Markers / blood Creatinine / blood Echocardiography Electrocardiography Female Humans Infarction / complications*, diagnosis, drug therapy International Normalized Ratio Israel Kidney / blood supply*, metabolism, physiopathology L-Lactate Dehydrogenase / blood Male Middle Aged Patient Admission Renal Artery Obstruction / complications*, drug therapy, physiopathology Renal Circulation / physiology Retrospective Studies Stroke Volume / physiology Tomography, X-Ray Computed Urea / blood Warfarin / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Biological Markers; 57-13-6/Urea; 60-27-5/Creatinine; 81-81-2/Warfarin; EC 1.1.1.27/L-Lactate Dehydrogenase |
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