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A rare case of renal infarction caused by infective endocarditis

Nature Reviews Urology volume 6, pages 568–572 (2009)Cite this article

Abstract

Background. A 29-year-old man presented to the emergency department of a general hospital complaining of sudden onset left loin pain, radiating to the groin, which had started 48 h previously. He described no urological symptoms and had no medical history of note.

Investigations. Physical examination, electrocardiography, dipstick testing of urine, radiography of the chest and abdomen, blood tests (white blood cell count and serum urea, creatinine, sodium, potassium and C-reactive protein levels), CT of the renal tract, blood and urine cultures, renal angiography, thromboembolic blood panel, urine and blood tests for illicit drugs, transthoracic echocardiography, transesophageal echocardiography, renal ultrasonography.

Diagnosis. Infective endocarditis resulting in thromboembolic unilateral renal infarction.

Management. The patient was started on anticoagulation therapy with low-molecular-weight heparin and treated with intravenous gentamicin and benzylpenicillin for 4 weeks. He was seen in an outpatient clinic 4 weeks after discharge, at which time serum urea and creatinine levels and repeat ultrasonography of the renal tract confirmed normal renal function. He will be followed up regularly by cardiologists and urologists, at 6 weeks initially, and every 6 months to 1 year thereafter by his family physician.

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Figure 1: Contrast-enhanced CT scan of the patient on presentation.
Figure 2: Renal angiography 72 h after admission.
Figure 3: Transthoracic echocardiography 72 h after admission.

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Authors and Affiliations

  1. Department of Urology, Ealing Hospital National Health Service Trust, London, UK

    Rasheed Zakaria, Vhari Forsyth & Tomas Rosenbaum

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  1. Rasheed Zakaria
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  2. Vhari Forsyth
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  3. Tomas Rosenbaum
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Correspondence to Rasheed Zakaria.

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The authors declare no competing financial interests.

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Zakaria, R., Forsyth, V. & Rosenbaum, T. A rare case of renal infarction caused by infective endocarditis. Nat Rev Urol 6, 568–572 (2009). https://doi.org/10.1038/nrurol.2009.176

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