Long-Term Follow-Up Results of Acute Renal Embolism after Anticoagulation Therapy

Title
Long-Term Follow-Up Results of Acute Renal Embolism after Anticoagulation Therapy
Author(s)
윤우성
Keywords
INFARCTION
Issue Date
201504
Publisher
ELSEVIER SCIENCE INC
Citation
ANNALS OF VASCULAR SURGERY, v.29, no.3
Abstract
Background: Acute renal embolism (ARE) is a rare cause of acute abdominal pain. However, there are only a few studies on the clinical course of ARE. We attempted to investigate the clinical manifestations and long-term follow-up results of ARE. Methods: From September 2006 to August 2012, 47 patients, who were diagnosed with ARE by computed tomography (CT), were enrolled. Patient demographic and clinical data were retrospectively reviewed. For the long-term outcomes, change in the serum creatinine (s-Cr) level, change in renal infarction on follow-up CT, recurrent embolism, and dialysis-free survival were investigated. Results: The mean age of patients was 61 years (range, 29-89 years), and 51% of the patients were men. All the patients presented with abdominal or flank pain. The sites of ARE were the right kidney in 57% of the patients, the left kidney in 36% of the patients, and both the kidneys in 6% of the patients. The infarction volume was less than 50% of renal volume in 54% of infarcted kidneys. Six patients had a concurrent infarction in other organs (3 cases of splenic infarction and 3 cases of cerebral infarction). Etiology of embolism was cardiogenic in 55% and idiopathic in 45%. Mean s-Cr level was 1.2 mg/dL (range, 0.6e3.7 mg/dL). s-Cr elevation >0.5 mg/dL was detected in 19% of patients during the follow-up (6 of 31 patients; mean duration, 31 months). Follow-up CT was performed in 23 patients (mean duration, 29 months). The infarcted lesions showed atrophic changes in all the cases except for 1 case. During the mean follow-up period of 41 months (1-118 months), recurrent embolism developed in 8 patients (6 cases of cerebral artery embolism, 1 case of superior mesenteric artery embolism, and 1 case of renal artery embolism). Dialysis was necessary in 1 patient, and dialysis-free survival rates were 91%, 82%, and 64% at 1 year, 3 years, and 5 years, respectively. Conclusions: Although ARE causes irreversible loss of renal mass, it rarely leads to end-stage renal disease or long-term mortality. Therefore, the treatment should focus on the prevention of subsequent embolism to other vital organs.
URI
http://hdl.handle.net/YU.REPOSITORY/32679http://dx.doi.org/10.1016/j.avsg.2014.09.028
ISSN
0890-5096
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의과대학 > 성형외과학교실 > Articles
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