Acil Bölümünde Nadir Bir Tanı: Renal Enfarktüs

Year 2022, Volume: 32 Issue: 3, 293 - 297, 01.08.2022

Mehtap Gürger

https://doi.org/10.54005/geneltip.1094602

Abstract

ÖZ
Amaç: Renal kan akımının ani kesilmesi sonucu oluşan renal enfarktüs (RE), nadir görülen bir hastalıktır. Bu çalışmada acil bölümünde RE tanısı konulan hastaların demografik ve klinik özellikleri ve sonuçlarını araştırmayı planladık.
Gereç ve Yöntem: 2010-2021 yılları arasında karın/yan ağrısı, bulantı, kusma şikayeti ile acil servise başvuran ve çekilen kontrastlı batın bilgisayarlı tomografisinde akut renal enfarkt tanısı konulan 18 yaşından büyük hastalar çalışmaya dahil edildi. Hastaların verileri retrospektif tarandı. Hastaların demografik, klinik özellikleri ve laboratuvar sonuçları kaydedildi.
Bulgular: Çalışmaya 38 hasta dahil edildi. Hastaların ortalama yaşı 61.8±18 idi ve % 63.2’si (n=24) erkekti. Hastaların en sık şikayetleri karın ağrısı (%84.2), yan ağrısı (%68,4) ve bulantı-kusma (%50) idi. Daha nadir olarak göğüs ağrısı, dispne ve ateş vardı. 4 hastada (%10.5) akut böbrek yetmezliği gelişti. Hastaların sadece üçünde (%7.9) bilinen bir hastalık yok iken diğerlerinde hipertansiyon (%31.6), iskemik kalp hastalığı (%31.6), geçirilmiş tromboembolik olaylar (%31.6), diabet (%26.3), kanser (%23.7), kalp yetmezliği (%21.1) ve atriyal fibrilayon (%18.4) gibi eşlik eden önemli hastalıklar vardı. RE’e neden olan en sık neden kardiyoembolik olaylar (% 44.7) iken bunu sırası ile hiperkoagülabilite (%28.9), renal arter hasarı (%15.8) ve idiopatik nedenler (%10.5) izledi.
Sonuç: Akut RE acil bölümünde nadiren tespit edilen bir hastalık olup spesifik klinik bulguları olmaması nedeni sıklıkla gözden kaçar veya geç tanı konur. Tanıdaki gecikme önemli morbidite ve mortaliteye neden olabilir. Özellikle tromboembolizm riski yüksek olan ve açıklanamayan karın ağrısı, yan ağrısı şikayeti ile acil bölümüne başvuran hastalarda akut RE tanısı akla gelmelidir.

Keywords

renal, enfarktüs, acil, bölümü

Supporting Institution

Destekleyen kurum bulunmamaktadır

A Rare Diagnosis in the Emergency Department: Renal Infarction

Abstract

Objective: Renal infarction (RI), which is caused by sudden cessation of renal blood flow, is a rare disease. In this study, we planned to investigate the demographic and clinical characteristics and outcomes of patients diagnosed with renal infarction in the emergency department.
Material and Methods: Patients over the age of 18 who presented to the emergency department with abdominal/flank pain, nausea, and vomiting between 2010 and 2021 and were diagnosed with acute renal infarction in contrast-enhanced abdominal computed tomography were included in the study. The data of the patients were reviewed retrospectively. Demographic and clinical characteristics, as well as laboratory results of the patients, were recorded.
Results: A total of 38 patients were included in the study. The mean age of the patients was 61.8±18 years and 63.2% (n=24) were male. The most common complaints of the patients were abdominal pain (84.2%), flank pain (68.4%), and nausea-vomiting (50%). More rarely, patients complained about chest pain, dyspnea, and fever. Acute renal failure developed in 4 patients (10.5%). While only three (7.9%) of the patients had no known disease, the others had comorbidities such as hypertension (31.6%), ischemic heart disease (31.6%), previous thromboembolic events (31.6%), diabetes (26.3%), cancer (23.7%), heart failure (21.1%), and atrial fibrillation (18.4%). The most common cause of RI was cardioembolic events (44.7%), followed by hypercoagulability (28.9%), renal artery damage (15.8%), and idiopathic causes (10.5%).
Conclusion: Acute RI is a disease that is rarely detected in the emergency department. Because there is a lack of specific clinical findings, it is often overlooked or diagnosed late. Delay in diagnosis can significantly cause morbidity and mortality. The diagnosis of acute RI should be considered especially in patients with a high risk of thromboembolism and who present to the emergency department with complaints of unexplained abdominal or flank pain.

Keywords

renal, infarction, emergency, department

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