Bolderman Rob, Oyen Raymond, Verrijcken Anton, Knockaert Daniël, Vanderschueren Steven
Department of General Internal Medicine, University Hospital, Leuven, Belgium.
Am J Med. 2006 Apr;119(4):356.e9-12. doi: 10.1016/j.amjmed.2005.06.049.
Renal infarction may be an underrecognized disorder. Classical teaching holds that cardioemboli, notably in the setting of arterial fibrillation, are responsible. The expanding use of contrast enhanced computed tomography (CT) in patients with acute abdomen may change the spectrum of renal infarction.
Twenty-seven consecutive patients presenting to a single university hospital with nontraumatic CT-documented acute renal infarction were studied and stratified according to the presence or absence of cardiac disease, either obvious at presentation or detected during work-up.
Eleven patients (41%) had obvious cardiac disease, including atrial fibrillation in all but one. Sixteen patients (59%) had no discernible structural or arrhythmic cardiac disease and were classified as idiopathic group. Patients in the idiopathic group were significantly younger (median age in years [interquartile range]: 48 [41-53] versus 75 [53-82] years, P = .003) and, besides smoking, had fewer traditional cardiovascular risk factors.
Acute renal infarction may occur in individuals of middle age without risk factors for cardioembolism. In patients with renal colic without lithiasis the diagnosis of renal infarction should be considered especially if serum lactate dehydrogenase is elevated, even in the absence of atrial fibrillation.
肾梗死可能是一种未被充分认识的疾病。传统观点认为，心脏栓子，尤其是在房颤情况下，是其病因。急性腹痛患者中对比增强计算机断层扫描（CT）的广泛应用可能会改变肾梗死的疾病谱。
对连续27例到某单一大学医院就诊、经非创伤性CT证实为急性肾梗死的患者进行研究，并根据就诊时是否存在心脏病或检查过程中是否发现心脏病进行分层。
11例患者（41%）有明显的心脏病，除1例患者外均为房颤。16例患者（59%）无明显的结构性心脏病或心律失常，被归类为特发性组。特发性组患者明显更年轻（年龄中位数[四分位间距]：48[41 - 53]岁对75[53 - 82]岁，P = 0.003），除吸烟外，传统心血管危险因素较少。
无心脏栓塞危险因素的中年人可能发生急性肾梗死。在无结石的肾绞痛患者中，即使没有房颤，特别是血清乳酸脱氢酶升高时，也应考虑肾梗死的诊断。
