Kidney: thromboembolism
Introduction
- Occlusion of renal artery or vein with a thrombus or embolism.
- Cause: hypercoagulable state, most commonly: secondary to cardiac disease.
- Signs: acute renal failure Kidney: acute renal failure; asymptomatic for small thrombi/emboli.
- Diagnosis: clinical findings consistent with acute renal failure: azotemia, electrolyte disturbances, metabolic acidosis, variably concentrated urine, uremia.
- Treatment: medical or surgical removal of embolus, manage renal failure/underlying disease.
- Prognosis: good if small, guarded to poor for large vessels, dependent on underlying disease.
Presenting signs
- Asymptomatic.
- Signs related to underlying disease which causes hypercoagulable state/cardiac disease.
Acute presentation
- Signs of acute renal failure (seizures, oliguria, anuria, vomiting, anorexia, lethargy, abdominal pain).
Pathogenesis
Etiology
Abnormal blood flow
- Hypertrophic cardiomyopathy Heart: hypertrophic cardiomyopathy.
- Dilated cardiomyopathy Heart: dilated cardiomyopathy (DCM).
Hypercoagulation
- Hyperadrenocorticism Hyperadrenocorticism.
- Nephrotic syndrome Nephrotic syndrome.
- Auto-immune hemolytic anemia Anemia: immune-mediated hemolytic.
- DIC.
- Hyperviscosity/polycythemia.
Trauma
- Septic.
- Trauma, eg to large or small renal vessels at surgery; road traffic accident.
- Iatrogenic, eg after "Tru-cut" liver biopsy.
Pathophysiology
- Occlusion of the renal artery or vein with a thrombus or embolism. Requires one or more of the following: hypercoagubable state, vascular stasis, endothelial damage.
- Thrombus/embolus in major renal vessel → renal ischemia Kidney: ischemia and tubular damage → acute renal failure if extensive renal damage.
- Thrombus/embolus in a smaller vessel → occluded → renal infarct → ischemia → damaged renal tissue.
Timecourse
- Acute.
Diagnosis
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Treatment
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Prevention
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Outcomes
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