Interprofessional Clinical Management of Renal Infarction-An Integrated Nursing, Pharmacy, and Laboratory Approach
Abstract
Background: Renal infarction is an uncommon but clinically significant ischemic condition caused by obstruction of the renal arterial system, often linked to cardioembolic disorders, thrombosis, hypercoagulable states, and traumatic or iatrogenic vascular injury. Its nonspecific symptoms frequently lead to misdiagnosis, delaying timely intervention.
Aim: This study aims to provide an integrated, interprofessional overview of the etiology, clinical presentation, diagnostic approach, and management strategies of renal infarction involving nursing, pharmacy, and laboratory perspectives.
Methods: A comprehensive analysis of current literature and multidisciplinary clinical practices provides an evidencebased synthesis of epidemiology, pathophysiology, diagnostic modalities, and therapeutic interventions, emphasizing interprofessional collaboration.
Results: Renal infarction most commonly results from cardioembolic events, particularly atrial fibrillation, followed by thrombosis, aortic dissection, trauma, hypercoagulable states, and atheroembolic disease. Diagnosis relies on high clinical suspicion, elevated LDH, urinalysis abnormalities, and contrastenhanced CT imaging. Management includes catheterdirected thrombolysis, anticoagulation, surgical interventions when indicated, and longterm secondary prevention through riskfactor control.
Conclusion: Early recognition and coordinated interprofessional management significantly improve renal and systemic outcomes. Timely diagnosis, targeted therapy, and ongoing patient education are essential to reducing morbidity and preventing recurrence.
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References
Scolari F, Ravani P, Gaggi R, Santostefano M, Rollino C, Stabellini N, Colla L, Viola BF, Maiorca P, Venturelli C, Bonardelli S, Faggiano P, Barrett BJ. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Circulation. 2007 Jul 17;116(3):298-304.
Markabawi D, Singh-Gambhir H. Acute renal infarction: A diagnostic challenge. Am J Emerg Med. 2018 Jul;36(7):1325.e1-1325.e2.
Khokhar S, Garcia D, Thirumaran R. A rare case of renal infarction due to heroin and amphetamine abuse: case report. BMC Nephrol. 2022 Jan 12;23(1):28.
Saeed K. Renal infarction. Int J Nephrol Renovasc Dis. 2012;5:119-23.
Seetho IW, Bungay PM, Taal MW, Fluck RJ, Leung JC. Renal infarction in patients presenting with suspected renal colic. NDT Plus. 2009 Oct;2(5):362-4.
Bourgault M, Grimbert P, Verret C, Pourrat J, Herody M, Halimi JM, Karras A, Amoura Z, Jourde-Chiche N, Izzedine H, François H, Boffa JJ, Hummel A, Bernadet-Monrozies P, Fouque D, Canouï-Poitrine F, Lang P, Daugas E, Audard V. Acute renal infarction: a case series. Clin J Am Soc Nephrol. 2013 Mar;8(3):392-8.
Pizzarossa AC, Mérola V. [Etiology of renal infarction. A systematic review]. Rev Med Chil. 2019 Jul;147(7):891-900.
Mesiano P, Rollino C, Beltrame G, Ferro M, Quattrocchio G, Fenoglio R, Pozzato M, Cecere P, Forneris G, Bazzan M, Macchia G, Roccatello D. Acute renal infarction: a single center experience. J Nephrol. 2017 Feb;30(1):103-107.
Yang J, Lee JY, Na YJ, Lim SY, Kim MG, Jo SK, Cho W. Risk factors and outcomes of acute renal infarction. Kidney Res Clin Pract. 2016 Jun;35(2):90-5.
Oh YK, Yang CW, Kim YL, Kang SW, Park CW, Kim YS, Lee EY, Han BG, Lee SH, Kim SH, Lee H, Lim CS. Clinical Characteristics and Outcomes of Renal Infarction. Am J Kidney Dis. 2016 Feb;67(2):243-50.
Caravaca-Fontán F, Pampa Saico S, Elías Triviño S, Galeano Álvarez C, Gomis Couto A, Pecharromán de las Heras I, Liaño F. Acute renal infarction: Clinical characteristics and prognostic factors. Nefrologia. 2016;36(2):141-8.
Hall SK. Acute renal vascular occlusion: an uncommon mimic. J Emerg Med. 1993 Nov-Dec;11(6):691-700.
Henry CM, MacEneaney P, Browne G. Spontaneous renal artery dissection: an elusive diagnosis. BMJ Case Rep. 2021 Sep 27;14(9)
Kuo TT, Huang CY, Chen PL, Chen IM, Shih CC. Impact of Renal Artery Stent-Graft Placement on Renal Function in Chronic Aortic Dissection. J Vasc Interv Radiol. 2019 Jul;30(7):979-986.
Varennes L, Tahon F, Kastler A, Grand S, Thony F, Baguet JP, Detante O, Touzé E, Krainik A. Fibromuscular dysplasia: what the radiologist should know: a pictorial review. Insights Imaging. 2015 Jun;6(3):295-307.
Van den Driessche A, Van Hul E, Ichiche M, Verpooten GA, Bosmans JL. Fibromuscular dysplasia presenting as a renal infarction: a case report. J Med Case Rep. 2010 Jun 30;4:199.
Abi Doumet A, Bustos B, Garrell J, Salman M, Haider L. Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction: A Case Report and Review of Two Diseases. Cureus. 2023 Mar;15(3):e35933.
Baradhi KM, Bream P. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 10, 2023. Fibromuscular Dysplasia.
Antopolsky M, Simanovsky N, Stalnikowicz R, Salameh S, Hiller N. Renal infarction in the ED: 10-year experience and review of the literature. Am J Emerg Med. 2012 Sep;30(7):1055-60.
Saarinen HJ, Palomäki A. Acute renal infarction resulting from fibromuscular dysplasia: a case report. J Med Case Rep. 2016 May 10;10(1):118.
Bemanian S, Motallebi M, Nosrati SM. Cocaine-induced renal infarction: report of a case and review of the literature. BMC Nephrol. 2005 Sep 22;6:10.
Ammous A, Ghaffar MA, El-Charabaty E, El-Sayegh S. Renal infarction in COVID-19 patient. J Nephrol. 2021 Feb;34(1):267-268.
Haas M, Spargo BH, Wit EJ, Meehan SM. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis. 2000 Mar;35(3):433-47.
Rudnick MR, Berns JS, Cohen RM, Goldfarb S. Nephrotoxic risks of renal angiography: contrast media-associated nephrotoxicity and atheroembolism--a critical review. Am J Kidney Dis. 1994 Oct;24(4):713-27.
Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010 May 08;375(9726):1650-60.
Mannesse CK, Blankestijn PJ, Man in 't Veld AJ, Schalekamp MA. Renal failure and cholesterol crystal embolization: a report of 4 surviving cases and a review of the literature. Clin Nephrol. 1991 Nov;36(5):240-5.
Thadhani RI, Camargo CA, Xavier RJ, Fang LS, Bazari H. Atheroembolic renal failure after invasive procedures. Natural history based on 52 histologically proven cases. Medicine (Baltimore). 1995 Nov;74(6):350-8.
Li X, Bayliss G, Zhuang S. Cholesterol Crystal Embolism and Chronic Kidney Disease. Int J Mol Sci. 2017 May 24;18(6)
Ivanes F, Dewaele J, Touboul C, Gatault P, Sautenet B, Barbet C, Büchler M, Quilliet L, Angoulvant D, Halimi JM. Renal arteriography with endovascular ultrasound for the management of renal infarction patients. BMC Nephrol. 2020 Jul 14;21(1):273.
Domanovits H, Paulis M, Nikfardjam M, Meron G, Kürkciyan I, Bankier AA, Laggner AN. Acute renal infarction. Clinical characteristics of 17 patients. Medicine (Baltimore). 1999 Nov;78(6):386-94.
Huang CC, Lo HC, Huang HH, Kao WF, Yen DH, Wang LM, Huang CI, Lee CH. ED presentations of acute renal infarction. Am J Emerg Med. 2007 Feb;25(2):164-9.
Komolafe B, Dishmon D, Sultan W, Khouzam RN. Successful aspiration and rheolytic thrombectomy of a renal artery infarct and review of the current literature. Can J Cardiol. 2012 Nov-Dec;28(6):760.e1-3.
Raja A, Karch J, Shih AF, De La Garza H, De Zepeda Diaz AJ, Maymone MBC, Phillips TJ, Secemsky E, Vashi N. Part II: Cutaneous manifestations of peripheral vascular disease. J Am Acad Dermatol. 2023 Aug;89(2):211-226.
Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987 Oct;38(10):769-84.
Korzets Z, Plotkin E, Bernheim J, Zissin R. The clinical spectrum of acute renal infarction. Isr Med Assoc J. 2002 Oct;4(10):781-4.
Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A., Cholesterol Embolism Study(CHEST) Investigators. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. 2003 Jul 16;42(2):211-6.
Lin JW, Tsai JH, Huang CH, Lin TK. Early Diagnosis and Intervention of Acute Renal Infarction with Catheter-Directed Thrombolytic Therapy. Acta Cardiol Sin. 2022 Mar;38(2):134-140.
Kaufman EJ, Mahabadi N, Munakomi S, Patel BC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 11, 2024. Hollenhorst Plaque.
Paris B, Bobrie G, Rossignol P, Le Coz S, Chedid A, Plouin PF. Blood pressure and renal outcomes in patients with kidney infarction and hypertension. J Hypertens. 2006 Aug;24(8):1649-54.
Gasparini M, Hofmann R, Stoller M. Renal artery embolism: clinical features and therapeutic options. J Urol. 1992 Mar;147(3):567-72.
Bolderman R, Oyen R, Verrijcken A, Knockaert D, Vanderschueren S. Idiopathic renal infarction. Am J Med. 2006 Apr;119(4):356.e9-12.
Winzelberg GG, Hull JD, Agar JW, Rose BD, Pletka PG. Elevation of serum lactate dehydrogenase levels in renal infarction. JAMA. 1979 Jul 20;242(3):268-9.
Wilson DM, Salazer TL, Farkouh ME. Eosinophiluria in atheroembolic renal disease. Am J Med. 1991 Aug;91(2):186-9.
Cosio FG, Zager RA, Sharma HM. Atheroembolic renal disease causes hypocomplementaemia. Lancet. 1985 Jul 20;2(8447):118-21.
Kasinath BS, Lewis EJ. Eosinophilia as a clue to the diagnosis of atheroembolic renal disease. Arch Intern Med. 1987 Aug;147(8):1384-5. [
Haqqie SS, Urizar RE, Singh J. Nephrotic-range proteinuria in renal atheroembolic disease: report of four cases. Am J Kidney Dis. 1996 Oct;28(4):493-501.
Fries C, Roos M, Gaspert A, Vogt P, Salomon F, Wüthrich RP, Vavricka SR, Fehr T. Atheroembolic disease--a frequently missed diagnosis: results of a 12-year matched-pair autopsy study. Medicine (Baltimore). 2010 Mar;89(2):126-132.
Greenberg A, Bastacky SI, Iqbal A, Borochovitz D, Johnson JP. Focal segmental glomerulosclerosis associated with nephrotic syndrome in cholesterol atheroembolism: clinicopathological correlations. Am J Kidney Dis. 1997 Mar;29(3):334-44.
Hazanov N, Somin M, Attali M, Beilinson N, Thaler M, Mouallem M, Maor Y, Zaks N, Malnick S. Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation. Medicine (Baltimore). 2004 Sep;83(5):292-299.
Muro K, Kobayashi T, Yanagita M. The cortical rim sign in graft renal infarction. Clin Exp Nephrol. 2019 Sep;23(9):1169-1170.
Piccoli GB, Priola AM, Vigotti FN, Guzzo G, Veltri A. Renal infarction versus pyelonephritis in a woman presenting with fever and flank pain. Am J Kidney Dis. 2014 Aug;64(2):311-4.
Lengelé JP, Christophe JL, Persu A. Renal infarction management: towards an etiological approach? J Hypertens. 2018 Mar;36(3):490-492.
Kang Y, Wu Q, Xu J, Hong M, Ma Y, Tang X, Zhu L, Gao P, Wang J. Intravascular ultrasound provides additional insights in the hypertensive patients with focal renal artery fibromuscular dysplasia. Hypertens Res. 2023 Jun;46(6):1407-1416.
Greenberg JM, Steiner MA, Marshall JJ. Acute renal artery thrombosis treated by percutaneous rheolytic thrombectomy. Catheter Cardiovasc Interv. 2002 May;56(1):66-8.
Silverberg D, Menes T, Rimon U, Salomon O, Halak M. Acute renal artery occlusion: Presentation, treatment, and outcome. J Vasc Surg. 2016 Oct;64(4):1026-32.
Lim JL, Lau KK, Lim AKH. Successful rescue from kidney failure with delayed catheter-directed intervention after catastrophic bilateral kidney paradoxical thromboembolism. BMJ Case Rep. 2022 Feb 10;15(2)
Koivuviita N, Tertti R, Heiro M, Manner I, Metsärinne K. Thromboembolism as a cause of renal artery occlusion and acute kidney injury: the recovery of kidney function after two weeks. Case Rep Nephrol Urol. 2014 Jan;4(1):82-7.
Heidemann F, Kölbel T, Debus ES, Diener H, Carpenter SW, Rohlffs F, Tsilimparis N. Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching. J Endovasc Ther. 2018 Aug;25(4):466-473.
Robinson S, Nichols D, Macleod A, Duncan J. Acute renal artery embolism: a case report and brief literature review. Ann Vasc Surg. 2008 Jan;22(1):145-7.
Hassanein M, Saleh Y, Randhawa M, Karve M. Renal artery embolism successfully managed by ultrasound enhanced catheter directed thrombolysis. Egypt Heart J. 2018 Dec;70(4):447-450.
Karakurt A. New Thrombolytic Infusion Application of Dissolving Renal Artery Embolic Thrombosis: Low-Dose Slow-Infusion Thrombolytic Therapy. Case Rep Nephrol. 2018;2018:1609025.
Chondros K, Karpathakis N, Tsetis D, Sofras F, Mamoulakis C. Systemic thrombolysis with the use of tenecteplase for segmental acute renal in-farction potentially associated with multiple thrombophilic gene polymorphisms. Hippokratia. 2014 Jan;18(1):67-70.
Kim H, Zhen DB, Lieske JC, McBane RD, Grande JP, Sandhu GS, Melduni RM. Treatment of Cholesterol Embolization Syndrome in the Setting of an Acute Indication for Anticoagulation Therapy. J Med Cases. 2014 Jun 01;5(6):376-379.
Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis. 1999 May;33(5):840-50.
Scolari F, Ravani P, Pola A, Guerini S, Zubani R, Movilli E, Savoldi S, Malberti F, Maiorca R. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J Am Soc Nephrol. 2003 Jun;14(6):1584-90.
Colburn S, Childers WK, Chacon A, Swailes A, Ahmed FM, Sahi R. The cost of seeking an edge: Recurrent renal infarction in setting of recreational use of anabolic steroids. Ann Med Surg (Lond). 2017 Feb;14:25-28.
Bae EJ, Hwang K, Jang HN, Kim MJ, Jeon DH, Kim HJ, Cho HS, Chang SH, Park DJ. A retrospective study of short- and long-term effects on renal function after acute renal infarction. Ren Fail. 2014 Oct;36(9):1385-9.
Kwon JH, Oh BJ, Ha SO, Kim DY, Do HH. Renal Complications in Patients with Renal Infarction: Prevalence and Risk Factors. Kidney Blood Press Res. 2016;41(6):865-872.
Heung M, Chawla LS. Predicting progression to chronic kidney disease after recovery from acute kidney injury. Curr Opin Nephrol Hypertens. 2012 Nov;21(6):628-34.
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Copyright (c) 2024 Omar Abdullah M Alanazi, Abdullah Gharamah Ayed Alasmari, Abdullah Hassan Asaad Alfaifi, AFRAH ALI A SAHLI, Saleha Yahya Barakat, Elham Ali A Mahnashi, Seham Abdulrahman Al Abu Ageel, Meshal Muflih Al Mutairi, Ali Abdullah Alhanaya, Waleed Salem Said, Amer Mohamed Abdollah Aldosari, Safi Saad Abdullah Aldosari, Jmaan Abdullah Jmaan Aldosary

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