A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report

Abstract

Background: Atrial fibrillation is one of the most common arrhythmias. The main thrombotic complication of arterial fibrillation is ischemic stroke, but it can also cause acute renal infarction from embolization. The low incidence and nonspecific clinical manifestations of acute renal infarction make it difficult to diagnose, often leading to either delayed diagnosis or misdiagnosis. Due to its rarity, more efficient treatment guidelines are helpful for the management of acute renal infarction related to the thromboembolic complication of arterial fibrillation.

Case reports: We report a case of acute renal infarction due to underlying arterial fibrillation, where a novel interventional therapeutic method was used. A 66-year-old Chinese man with arterial fibrillation, not on anticoagulation due to the patient's preference, and coronary artery disease post-percutaneous coronary intervention to left anterior descending artery about 1 year ago, was currently on dual antiplatelet therapy. He suddenly developed intermittent and sharp left-sided abdominal pain and was found to have an acute left renal infarction on computed tomography scan. Angiogram showed acute occlusion of the left renal artery due to thromboembolism. For this patient, a combination method of local thrombus aspiration, angioplasty, and infusion of nitroglycerin and diltiazem were used, restoring blood flow to the left kidney. After recovery, the patient was discharged on aspirin, clopidogrel, and warfarin. At 6 months follow-up, there was no residual kidney dysfunction.

Conclusions: Acute renal infarction from thromboembolism is a rare but serious complication of arterial fibrillation. More efficient and different options for intervention methods will benefit the treatment of this disease. Here, we report a combination therapeutic method that has not been used in acute renal infarction associated with arterial fibrillation, and which restored renal perfusion and prevented long-term kidney injury.

Keywords: Abdominal pain; Acute renal infarction; Atrial fibrillation; Interventional therapy.

Fig. 1

Contrast-enhanced computed tomography (CT) scans of the abdomen with intravenous contrast showed perfusion defect in the left kidney (A, arrows), Aortogram (B), and electrocardiogram (EKG) (C)

Fig. 2

Intraoperative angiography images (a) Initial angiogram showing filling defects in the superior and inferior branches of the left renal artery (arrows); (b) Two guide wires were introduced into the superior and inferior segments of the renal artery; (c) The suction catheter was introduced into the distal end of the superior occlusion segment; (d) Angiogram after suction catheter aspiration; (e) Angiogram after balloon expansion; (f) The guide wire was introduced into the inferior occlusion segment; (g) Angiogram after microcatheter injection of drugs; (h) Angiogram showing restoration of flow to the superior and inferior branches of the left renal artery (arrows); (i) Amplification of upper insert (solid line square) in a; (j) Amplification of lower insert (dash line square) in h; (k) Amplification of upper insert (solid line square) in h; (l) Amplification of lower insert (dash line square) in h