Ongun Sakir, Bozkurt Ozan, Demir Omer, Cimen Sertac, Aslan Guven
Department of Urology, SB Siverek State Hospital, Sanliurfa, Turkey.
Department of Urology, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
Kaohsiung J Med Sci. 2015 Oct;31(10):529-33. doi: 10.1016/j.kjms.2015.07.005. Epub 2015 Aug 24.
The aim of this study was to explore clinical features of renal infarction (RI) that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT) and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA) only, whereas patients with atrial fibrillation (AF) or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR) referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD) formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9%) had elevated serum lactate dehydrogenase (LDH), 18 patients (78.2%) had leukocytosis, and 16 patients (69.5%) had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m(2) at admission and increased to 82.3 ± 23.4 mL/min/1.73 m(2) at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.
本研究的目的是探讨肾梗死（RI）的临床特征，这些特征可能在我们的患者队列的诊断和治疗中发挥作用，并提供中期肾功能的数据。对1998年至2012年期间在我们诊所住院的、经对比增强计算机断层扫描（CT）确诊为急性RI且至少有1年随访数据的患者的病历进行回顾性分析；包括描述性数据、临床体征和症状、病因、实验室检查结果以及所采用的治疗方法。孤立性梗死患者仅接受阿司匹林（ASA）治疗，而房颤（AF）或多发性或广泛性梗死患者接受抗凝治疗。采用肾脏病饮食改良（MDRD）公式确定反映肾功能的估计肾小球滤过率（eGFR）。共确定了23例急性RI患者的27个肾单位。平均年龄为59.7±15.7岁。14例（60.8%）RI患者以房颤（AF）为病因，其中4例在诊断时伴有肠系膜缺血。就诊时，20例（86.9%）患者血清乳酸脱氢酶（LDH）升高，18例（78.2%）患者白细胞增多，16例（69.5%）患者镜下血尿。2例伴有肠系膜缺血和房颤的患者在随访期间死亡。入院时平均eGFR为70.8±23.2 mL/min/1.73m²，1年随访时升至82.3±23.4 mL/min/1.73m²。对于持续性胁腹或腹痛患者，尤其是有血栓栓塞高风险的患者，应考虑肾梗死。根据梗死范围，抗血小板和/或抗凝药物都是保护肾功能的有效治疗选择。
