Renal Artery Embolism: Prospective Study of 41 Patients Based on a Diagnostic and Therapeutic Algorithm

Renal artery embolism (RAE) is an underdiagnosed condition leading to acute renal failure in patients with a single functioning kidney. We prospectively studied 41 patients according to a previously validated algorithm based on Lactate Dehydrogenase (LDH) determination, which enables us to identify RAE patients and allocate them to a different protocolled treatment. The most frequent symptom was atypical low back pain. Atrial fibrillation was present in 65.8% of patients. The most frequent site of the embolism was the main renal artery of a single kidney. Surgery was performed in 13 patients, fibrinolytic treatment in 17 and anticoagulation in 11. Mean LDH levels were 1690 ± 1108 U/L. Oliguria was present in 15 patients. Hemodialysis requirements were not different between patients with main RAE or intrarenal embolism, or according to treatment group. Conclusions: Our results indicate that the use of a diagnostic algorithm based on LDH values is useful for identifying RAE patients. Further randomized trials are needed to compare results on treatment.