Usefulness of serum d-dimer level in acute renal infarction

Abstract

Acute renal infarction (ARI) is a rarely encountered disease in emergency services, but is of particular importance owing to higher mortality and morbidity rates in the absence of early diagnosis and intervention. On the other hand, urolithiasis cases are admitted to emergency departments very frequently with the complaint of pain. ARI with non-specific symptoms or urolithiasis-like pain would increase the likelihood of being omitted in crowded emergency rooms. Previous studies reported supportive diagnostic role in ARI of increased serum lactate dehydrogenase and C-reactive protein levels and white blood cell count in the presence of hematuria; however, none mentioned D-dimer as a likely diagnostic or prognostic marker. We hereby present 2 case reports where a contrast-enhanced tomographic scan performed on the basis of suspicions raised by high serum D-dimer levels which established the definitive diagnosis ARI. Our aim was to emphasize that serum D-dimer may be used as a criterion for supporting or excluding the thromboembolic events, such as renal and mesenteric infarction.

Keywords

• Abdominal pain
• acute renal infarction
• emergency department
• renal artery thrombosis
• renal colic
• urolithiasis
• d-dimer

Project Number

Yok

References

1. 1. Korzets, Z., et al., The clinical spectrum of acute renal infarction. Isr Med Assoc J, 2002. 4(10): p. 781-4.
2. 2. Hoxie HJ, C.C., Hoxie HJ, Coggin CB. Renal infarction statistical study of 2 hundred and 5 cases and detailed report of an unusual case. Arch Intern Med, 1940. Hoxie HJ, Coggin CB. Renal infarction: p. 587-94.
3. 3. Paris, B., et al., Blood pressure and renal outcomes in patients with kidney infarction and hypertension. J Hypertens, 2006. 24(8): p. 1649-54.
4. 4. Caravaca-Fontan, F., et al., Acute renal infarction: Clinical characteristics and prognostic factors. Nefrologia, 2016. 36(2): p. 141-8.
5. 5. Asha, S.E. and J.W. Miers, A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection. Ann Emerg Med, 2015. 66(4): p. 368-78.
6. 6. Coskun, A.K., et al., The value of combined elevation of D-dimer and neopterin as a predictive parameter for early stage acute mesenteric ischemia: An experimental study. Vascular, 2017. 25(2): p. 163-169.
7. 7. Kumar, B. and S. Kumari, Spontaneous Renal Artery Thrombosis Successfully Intervened with Drug Eluting Stent: A Primary Renal Artery Angioplasty. J Clin Diagn Res, 2017. 11(9): p. OD14-OD15.
8. 8. Nandwani, A., et al., Renal Artery Thrombosis with Renal Infarction: A Rare Cause of Acute Abdomen. Indian J Nephrol, 2017. 27(4): p. 313-315.

9. 9. Singh, S., et al., Spontaneous renal artery thrombosis: an unusual cause of acute abdomen. N Am J Med Sci, 2014. 6(5): p. 234-6.