warfarin and Renal-Artery-Obstruction

Acute renal artery embolism is an uncommon clinical diagnosis. We present a case report of a patient who was treated with transcatheter thrombolysis and a literature review and discussion of this condition and its management.

Topics: Abdomen, Acute; Acute Disease; Anticoagulants; Embolism; Fibrinolytic Agents; Heparin; Humans; Male; Middle Aged; Radiography; Renal Artery Obstruction; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; Vascular Patency; Warfarin

Renal artery embolism was first described in 1940, but it is only recently becoming recognized as a clinically significant entity. Although relatively uncommon, it is clearly responsible for considerable morbidity in patients who experience it. The pathogenesis is typically related to cardiac thrombus formation with subsequent embolization, although other etiologies have been described. The authors present a case report followed by a review of the literature to highlight the clinical characteristics of this phenomena. Presentation, diagnostics, and treatment options will be reviewed with the aim of increasing awareness of renal artery embolism. As clinicians become more familiar with this condition, they will be more likely to consider it as a possible diagnosis in patients with a typical presentation. This will hopefully lead to improved care through prompt diagnosis and treatment, particularly as one treatment option may be time sensitive.

Topics: Aged; Aged, 80 and over; Anticoagulants; Biomarkers; Embolism; Female; Flank Pain; Heparin; Humans; Kidney Function Tests; Magnetic Resonance Imaging; Male; Radiography; Renal Artery Obstruction; Ultrasonics; Warfarin

Acute embolic renal infarction is an entity that is often misdiagnosed as a renal calculus because of similar presenting symptoms. This leads to delay in the initiation of treatment and to increased morbidity. Few case reports exist relating cardiac emboli to acute renal infarction. The authors present a patient with a renal embolism secondary to left ventricular thrombus. A brief review of the literature highlighting the importance of clinical suspicion in making an accurate diagnosis, the utility of various diagnostic studies, and comparison of various treatment options is presented.

Topics: Aged; Anticoagulants; Diagnosis, Differential; Female; Heparin; Humans; Infarction; Kidney; Kidney Calculi; Radiography; Renal Artery; Renal Artery Obstruction; Thromboembolism; Ventricular Outflow Obstruction; Warfarin

A 57-year-old woman with known moderate-to-severe mitral stenosis and atrial fibrillation (AF) presented to the emergency department with acute onset right loin pain after having a coronary angiogram and left and right heart catheterisation through the right femoral route about 28 h ago. The cardiac catheterisation was done after she presented with one episode of troponin-negative chest pain and progressive shortness of breath. She had anterior wall myocardial infarction (MI) 25 years ago, which was thought to be due to coronary artery embolism. Her mitral stenosis was diagnosed at that stage.Her warfarin was stopped for 5 days before cardiac catheterisation and international normalised ratio (INR) on the day of the procedure was 1.1. No bridging heparin/low molecular weight heparin (LMWH) was used and warfarin was restarted on the evening of the procedure at the usual dose. Clinical examination revealed some guarding in the right iliac fossa and some tenderness in the right loin. She was not feverish and there was no dysuria or frequency. There was no lump at the puncture site.On presentation to the emergency department, a contrast-enhanced CT scan of the abdomen was performed (figures 1 and 2).. Which of the following is the aetiology of the pain? Abdominal aortic dissectionRenal artery embolismRetroperitoneal haematomaUreteric stone.

Topics: Administration, Intravenous; Anticoagulants; Atrial Fibrillation; Cardiac Catheterization; Coronary Angiography; Drug Administration Schedule; Embolism; Female; Flank Pain; Heparin; Humans; International Normalized Ratio; Middle Aged; Mitral Valve Stenosis; Renal Artery Obstruction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Acute arterial thromboembolism to the renal arteries can be treated promptly by local thrombolysis, conventional surgical thrombectomy, or anticoagulation.. We report a patient who presented with acute loin pain as a result of atrial fibrillation-related thromboembolism to the right renal artery supplying his horseshoe kidney. He was already on warfarin treatment with international normalized ratio of 1.7 and had acute bleeding from malignant peptic ulcer disease, so thrombolysis was contraindicated.. He underwent timely endovascular revascularization with aspiration thrombectomy, with good clinical and radiological consequence. He subsequently underwent curative partial gastrectomy and made a steady recovery.. Early endovascular target-directed therapy such as intra-arterial thrombolysis and mechanical aspiration in combination with intravenous heparin therapy will result in renal salvage.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Computed Tomography Angiography; Fused Kidney; Gastrectomy; Humans; International Normalized Ratio; Male; Peptic Ulcer Hemorrhage; Renal Artery Obstruction; Stomach Ulcer; Thrombectomy; Thromboembolism; Treatment Outcome; Warfarin

Topics: Anticoagulants; Coronary Artery Disease; Dyspnea; Echocardiography, Transesophageal; Embolism; Foramen Ovale, Patent; Humans; Intracranial Embolism; Magnetic Resonance Angiography; Male; Middle Aged; Multimodal Imaging; Pulmonary Embolism; Renal Artery Obstruction; Ultrasonography, Doppler; Venous Thrombosis; Warfarin

We have demonstrated a point prevalence of 26% renal artery stenosis in patients with antiphospholipid syndrome (APS) and uncontrolled hypertension. We describe the effect of anticoagulation on blood pressure control and renal function.. We studied 23 patients retrospectively with renal artery stenosis (RAS). Fourteen received oral anticoagulation for more than 1 yr (target International Normalized Ratio (INR) of 3.0-4.5). Five patients had primary APS. Patients were divided into two groups based on their INR (< 3.0 and > or = 3.0). Nine patients had repeat magnetic resonance angiography (MRA) or an angiogram of the renal arteries after 2 yr.. Only 8/14 patients managed to maintain their INR > or = 3.0 (median INR 3.1, range 2.8-3.7) while six had a INR < 3.0 (median INR 1.9, range 1.2-2.4). Patients with a median INR < 3.0 had poorly controlled blood pressure and there was significant deterioration in mean serum creatinine values (Wilcoxon's test, P < 0.03). Nine patients underwent follow-up renal artery imaging. Three of nine patients with an INR < 3.0 (median INR 1.9) had re-stenosis and a fourth developed bilateral renal artery stenosis. Five patients with INR > or = 3.0 (median INR 3.1) did not show re-stenosis of the renal arteries; their renal function was stable and blood pressure was well controlled. One other patient with secondary APS (mixed connective tissue disorder) with INR > 3.0 showed recanalization of the stenosed renal artery.. Anticoagulation with INR maintained > or = 3.0 helped to control the blood pressure and prevent the progression of renal disease.

Topics: Anticoagulants; Antihypertensive Agents; Antiphospholipid Syndrome; Blood Pressure; Creatinine; Female; Humans; Hypertension; Magnetic Resonance Angiography; Male; Radiography; Renal Artery; Renal Artery Obstruction; Retrospective Studies; Treatment Outcome; Warfarin

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.

Topics: Acute Disease; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Biomarkers; Creatinine; Echocardiography; Electrocardiography; Female; Humans; Infarction; International Normalized Ratio; Israel; Kidney; L-Lactate Dehydrogenase; Male; Middle Aged; Patient Admission; Renal Artery Obstruction; Renal Circulation; Retrospective Studies; Stroke Volume; Tomography, X-Ray Computed; Urea; Warfarin

Female Sprague-Dawley rats underwent right nephrectomy and 40 min left renal artery occlusion (RAO). After 15 min of reflow, polyethylene glycol 1000 (PEG1000) was infused to induce osmotic diuresis and to enable glomerular filtration rate (GFR) measurements. Urine was collected during a 90 min period, and the concentrations of PEG1000, albumin, IgG, IgM and fibrin(ogen)/degradation products (FIB) were assessed both in plasma and urine by radial immuno diffusion technique Groups of rats were subjected to saline + RAO, warfarin + RAO or sham-operation. GFR as measured by PEG1000 clearance averaged 0.61, 0.036 and 0.094 mL/min/100g BW/kidney in sham-operated, saline + RAO and warfarin + RAO rats, respectively. Urinary excretion of albumin and IgG increased substantially in both ischemic groups. IgM was not detected in any of the urine samples. FIB excretion was lowest in the saline + RAO group, possibly due to retention of FIB-containing obstructions in the tubules. Rats subjected to warfarin + RAO had significantly higher excretion of FIB. This result suggests that warfarin does not prevent the glomerular sieving of macromolecules in the glomerular filter, but reduces tubular obstruction by preventing fibrin formation, which may explain its positive effect on GFR.

Topics: Acute Kidney Injury; Animals; Anticoagulants; Female; Fibrin Fibrinogen Degradation Products; Glomerular Filtration Rate; Kidney; Proteinuria; Rats; Rats, Sprague-Dawley; Renal Artery Obstruction; Warfarin

Topics: Adult; Blood Coagulation; Blood Coagulation Factors; Dipyridamole; Female; Follow-Up Studies; Humans; Male; Nephrotic Syndrome; Renal Artery Obstruction; Thrombolytic Therapy; Thrombosis; Time Factors; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Blood Platelets; Dipyridamole; Drug Evaluation; Drug Therapy, Combination; Glomerulonephritis; Graft Rejection; Humans; Kidney Glomerulus; Kidney Transplantation; Postoperative Complications; Renal Artery; Renal Artery Obstruction; Thrombosis; Transplantation, Homologous; Warfarin

Topics: Heparin; Humans; Male; Middle Aged; Peritoneal Dialysis; Renal Artery Obstruction; Streptokinase; Warfarin

Topics: Angiography; Embolism; Heparin; Humans; Injections, Intravenous; Male; Middle Aged; Renal Artery Obstruction; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Embolism; Female; Humans; Middle Aged; Renal Artery Obstruction; Rheumatic Heart Disease; Urography; Warfarin

Topics: Acute Disease; Angiography; Anti-Bacterial Agents; Anticoagulants; Embolism; Female; Humans; Middle Aged; Postoperative Care; Renal Artery Obstruction; Urography; Warfarin

Topics: Anticoagulants; Embolism; Humans; Hypertension, Pulmonary; Myocardial Infarction; Phenindione; Renal Artery Obstruction; Rheumatic Heart Disease; Thrombosis; Warfarin