Renal infarction in patient with long-standing ventricular aneurysm
Infarto renal en paciente con aneurisma ventricular antiguo
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] ] ] 7 => array:3 [ "nombre" => "Ana" "apellidos" => "Pérez de José" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 8 => array:3 [ "nombre" => "Nicolás" "apellidos" => "Macías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 9 => array:3 [ "nombre" => "José" "apellidos" => "Luño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto renal en paciente con aneurisma ventricular antiguo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11377_16025_28441_en_f1_11377_i.jpg" "Alto" => 949 "Ancho" => 2122 "Tamanyo" => 676855 ] ] "descripcion" => array:1 [ "en" => "Different computed tomography views of the right renal infarction" ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Renal infarction is an uncommon event that often goes undetected due to its symptoms and analytical data being non-specific.<span class="elsevierStyleSup">1</span> The most frequent causes of renal infarction are embolic events (due to atrial fibrillation, thromboembolism after a myocardial infarction or release of atheromatous plaque),<span class="elsevierStyleSup">2</span> although it may also be secondary to thrombosis<span class="elsevierStyleSup">3</span> or renal artery dissection.<span class="elsevierStyleSup">4</span> Typical clinical manifestations include nausea, vomiting and intractable abdominal pain, although renal infarction may also be asymptomatic.<span class="elsevierStyleSup">5</span> Ventricular aneurysms are a complication in 30% of anterior myocardial infarctions and they are accompanied by several additional complications, such as sustained ventricular tachycardia, arterial embolism or heart failure.<span class="elsevierStyleSup">6,7</span></p><p class="elsevierStylePara">We present the case of a patient with a renal infarction secondary to a ventricular aneurysm caused by a prior myocardial infarction.</p><p class="elsevierStylePara">The 61 year old patient came to the Emergency Department due to intense pain in the right renal fossa lasting 5 hours. Medical history included primary arterial hypertension, dyslipidaemia and an acute myocardial infarction in 1997 that was treated by placing a stent in the right coronary artery. The patient was undergoing treatment with acetylsalicylic acid, nitroglycerin, simvastatin and diltiazem. Physical examination revealed a blood pressure of 143/94mm Hg, heart rate of 84 beats per minute, and lack of a fever. The patient experienced intense pain in right renal fossa, with no other abnormalities.</p><p class="elsevierStylePara">The Emergency Department laboratory analysis found the following: haemoglobin, 13.5g/dl; leukocytes, 14 300/µl; platelet count, 201 000/µl; creatinine, 1.17mg/dl (baseline 1mg/dl); urea, 42mg/dl; sodium, 136mmol/l; potassium, 3.8mmol/l; alanine transaminase, 66IU/l; aspartate transaminase, 97IU/l; bilirubin, 0.9mg/dl; gamma-glutamyl transferase, 28IU/l; alkaline phosphatase, 43IU/l; lactate-dehydrogenase (LDH), 2124IU/l; creatine-kinase, 1210IU/l; C-reactive protein, 1.1mg/dl. The systematic urine analysis showed only 5-10 leukocytes per field.</p><p class="elsevierStylePara">Electrocardiography was performed, revealing sinus rhythm with several ventricular and atrial extrasystoles. The Emergency Department performed an abdominal ultrasound which showed no inflammatory changes in the right iliac fossa. It was concluded that the kidneys presented no significant abnormalities.</p><p class="elsevierStylePara">Given the patient’s intense pain and high LDH level, computed tomography was performed. The scan revealed an extensive right renal infarction with a filling defect in the main renal artery, proximal to its trifurcation (Figure 1).</p><p class="elsevierStylePara">The patient was admitted and began systemic anticoagulation therapy with heparin sodium.</p><p class="elsevierStylePara">The echocardiogram performed on the day after hospital admission showed akinesis of the inferior septum, inferior wall and distal third of all walls, with an aneurysm of the distal thirds of the anterior and lateral walls; left ventricular ejection fraction 35%; mild to moderate mitral regurgitation; and mild tricuspid regurgitation (Figure 2). A Holter monitor confirmed the presence of multiple ventricular extrasystoles.</p><p class="elsevierStylePara">During the following days, the patient’s renal function decreased to 1.6mg/dl, at which point it stabilised.</p><p class="elsevierStylePara">The interesting feature of this case is that thromboembolic events following an infarction due to a left ventricular thrombus usually appear in an early stage (the first 4 months),<span class="elsevierStyleSup">8</span> while in our patient, they occurred 15 years later. Likewise, in 80% of all cases, left ventricular aneurysms follow infarction of the anterior descending artery,<span class="elsevierStyleSup">9</span> while our patient had an occluded right coronary artery. At the present time, the option of fitting the patient with a defibrillator is being considered.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p><p class="elsevierStylePara"><a href="grande/11377_16025_28441_en_f1_11377_i.jpg" class="elsevierStyleCrossRefs"><img src="11377_16025_28441_en_f1_11377_i.jpg" alt="Different computed tomography views of the right renal infarction "></img></a></p><p class="elsevierStylePara">Figure 1. Different computed tomography views of the right renal infarction </p><p class="elsevierStylePara"><a href="grande/11377_16025_28442_en_f2_11377_i.jpg" class="elsevierStyleCrossRefs"><img src="11377_16025_28442_en_f2_11377_i.jpg" alt="Echocardiogram showing the ventricular aneurysm"></img></a></p><p class="elsevierStylePara">Figure 2. Echocardiogram showing the ventricular aneurysm</p>" "pdfFichero" => "P1-E534-S3443-A11377-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11377_16025_28441_en_f1_11377_i.jpg" "Alto" => 949 "Ancho" => 2122 "Tamanyo" => 676855 ] ] "descripcion" => array:1 [ "en" => "Different computed tomography views of the right renal infarction" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11377_16025_28442_en_f2_11377_i.jpg" "Alto" => 973 "Ancho" => 1023 "Tamanyo" => 359021 ] ] "descripcion" => array:1 [ "en" => "Echocardiogram showing the ventricular aneurysm" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1.\u{A0}Hazanov N, Somin M, Attali M, Beilinson N, Thaler M, Mouallem M,\u{A0}et al. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 9 | 15 |
| 2024 October | 50 | 31 | 81 |
| 2024 September | 64 | 22 | 86 |
| 2024 August | 56 | 43 | 99 |
| 2024 July | 58 | 25 | 83 |
| 2024 June | 69 | 49 | 118 |
| 2024 May | 82 | 31 | 113 |
| 2024 April | 68 | 36 | 104 |
| 2024 March | 44 | 21 | 65 |
| 2024 February | 43 | 40 | 83 |
| 2024 January | 44 | 22 | 66 |
| 2023 December | 35 | 28 | 63 |
| 2023 November | 51 | 35 | 86 |
| 2023 October | 48 | 34 | 82 |
| 2023 September | 45 | 36 | 81 |
| 2023 August | 47 | 20 | 67 |
| 2023 July | 61 | 27 | 88 |
| 2023 June | 62 | 23 | 85 |
| 2023 May | 61 | 40 | 101 |
| 2023 April | 45 | 30 | 75 |
| 2023 March | 48 | 19 | 67 |
| 2023 February | 43 | 21 | 64 |
| 2023 January | 43 | 21 | 64 |
| 2022 December | 54 | 35 | 89 |
| 2022 November | 49 | 38 | 87 |
| 2022 October | 34 | 43 | 77 |
| 2022 September | 56 | 25 | 81 |
| 2022 August | 62 | 43 | 105 |
| 2022 July | 38 | 40 | 78 |
| 2022 June | 45 | 29 | 74 |
| 2022 May | 47 | 37 | 84 |
| 2022 April | 69 | 43 | 112 |
| 2022 March | 48 | 43 | 91 |
| 2022 February | 55 | 41 | 96 |
| 2022 January | 66 | 28 | 94 |
| 2021 December | 51 | 37 | 88 |
| 2021 November | 54 | 39 | 93 |
| 2021 October | 52 | 38 | 90 |
| 2021 September | 48 | 41 | 89 |
| 2021 August | 66 | 41 | 107 |
| 2021 July | 64 | 33 | 97 |
| 2021 June | 48 | 24 | 72 |
| 2021 May | 66 | 32 | 98 |
| 2021 April | 119 | 53 | 172 |
| 2021 March | 98 | 41 | 139 |
| 2021 February | 85 | 26 | 111 |
| 2021 January | 52 | 16 | 68 |
| 2020 December | 35 | 12 | 47 |
| 2020 November | 54 | 13 | 67 |
| 2020 October | 38 | 18 | 56 |
| 2020 September | 49 | 7 | 56 |
| 2020 August | 61 | 10 | 71 |
| 2020 July | 35 | 7 | 42 |
| 2020 June | 63 | 7 | 70 |
| 2020 May | 50 | 11 | 61 |
| 2020 April | 42 | 18 | 60 |
| 2020 March | 28 | 7 | 35 |
| 2020 February | 57 | 18 | 75 |
| 2020 January | 56 | 18 | 74 |
| 2019 December | 53 | 17 | 70 |
| 2019 November | 44 | 15 | 59 |
| 2019 October | 21 | 10 | 31 |
| 2019 September | 33 | 20 | 53 |
| 2019 August | 23 | 10 | 33 |
| 2019 July | 24 | 16 | 40 |
| 2019 June | 35 | 14 | 49 |
| 2019 May | 30 | 7 | 37 |
| 2019 April | 64 | 19 | 83 |
| 2019 March | 45 | 20 | 65 |
| 2019 February | 31 | 20 | 51 |
| 2019 January | 51 | 18 | 69 |
| 2018 December | 88 | 38 | 126 |
| 2018 November | 91 | 21 | 112 |
| 2018 October | 85 | 16 | 101 |
| 2018 September | 75 | 14 | 89 |
| 2018 August | 69 | 16 | 85 |
| 2018 July | 49 | 12 | 61 |
| 2018 June | 61 | 15 | 76 |
| 2018 May | 62 | 19 | 81 |
| 2018 April | 51 | 12 | 63 |
| 2018 March | 61 | 15 | 76 |
| 2018 February | 52 | 11 | 63 |
| 2018 January | 50 | 8 | 58 |
| 2017 December | 54 | 12 | 66 |
| 2017 November | 40 | 6 | 46 |
| 2017 October | 42 | 11 | 53 |
| 2017 September | 31 | 12 | 43 |
| 2017 August | 29 | 8 | 37 |
| 2017 July | 41 | 16 | 57 |
| 2017 June | 45 | 7 | 52 |
| 2017 May | 54 | 15 | 69 |
| 2017 April | 59 | 10 | 69 |
| 2017 March | 43 | 7 | 50 |
| 2017 February | 30 | 12 | 42 |
| 2017 January | 25 | 15 | 40 |
| 2016 December | 46 | 7 | 53 |
| 2016 November | 67 | 12 | 79 |
| 2016 October | 118 | 13 | 131 |
| 2016 September | 112 | 3 | 115 |
| 2016 August | 141 | 4 | 145 |
| 2016 July | 192 | 11 | 203 |
| 2016 June | 127 | 0 | 127 |
| 2016 May | 134 | 0 | 134 |
| 2016 April | 111 | 0 | 111 |
| 2016 March | 97 | 0 | 97 |
| 2016 February | 108 | 0 | 108 |
| 2016 January | 129 | 0 | 129 |
| 2015 December | 121 | 0 | 121 |
| 2015 November | 91 | 0 | 91 |
| 2015 October | 97 | 0 | 97 |
| 2015 September | 74 | 0 | 74 |
| 2015 August | 78 | 0 | 78 |
| 2015 July | 75 | 0 | 75 |
| 2015 June | 37 | 0 | 37 |
| 2015 May | 40 | 0 | 40 |
| 2015 April | 7 | 0 | 7 |
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