Initial Management of Renal Infarction

Diagnosis

IV contrast-enhanced CT with immediate and delayed images is the recommended diagnostic imaging modality for suspected renal infarction 1
Duplex ultrasound (DUS) may be used as a first-line imaging modality when renal artery disease is suspected, but is less sensitive than CT for diagnosing renal infarction 2

Provide adequate fluid resuscitation with normal saline (0.9%) to maintain renal perfusion and prevent further kidney injury 3
Avoid potassium-containing balanced salt fluids such as Lactated Ringer's solution, as potassium levels may increase markedly even with intact renal function 3
Assess urine output regularly to detect oliguria or anuria 3
Monitor electrolytes, particularly potassium levels 3

Antiplatelet therapy with aspirin may be considered in patients with atherosclerotic renal artery disease 2

In hemodynamically unstable patients with renal infarction who do not respond to resuscitation, immediate intervention (surgery or angioembolization) should be performed 1
For patients with severe renal vascular injuries without self-limiting bleeding, surgical intervention is indicated 4
In patients with solitary kidney and moderate to severe renal trauma with arterial contrast extravasation on CT scan, angiography with super-selective angioembolization should be considered as the first choice 4
In patients with renal dysfunction, special attention must be given to proper dosing of antithrombotic medications 5

The European Society of Cardiology recommends estimating glomerular filtration rate (eGFR) as soon as possible after admission to guide medication dosing and contrast use, particularly in patients with renal dysfunction 6
Ensure proper hydration before and after contrast administration to minimize the risk of contrast-induced nephropathy, and limit the dose of contrast agents when possible, as suggested by the European Heart Journal 7
Pay meticulous attention to proper dosing of antithrombotic medications in patients with renal dysfunction, with adjustments applying when creatinine clearance is <60 mL/min, including no dose adjustment required for aspirin and clopidogrel 6, 7
For patients with creatinine clearance <30 mL/min, subcutaneous doses of enoxaparin should be given once every 24 hours instead of twice daily, following thrombolysis, as recommended by the European Heart Journal 6, 7