Clinical studies of interventional thrombolysis in treatment of primary acute segmental renal infarction / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the feasibility and clinical efficacy of the interventional thrombolytic therapy in acute segmental renal infarction.Methods From December 2007 to November 2015 data of patients with acute segmental renal infarction treated in our institute were retrospectively reviewed. There were 5 male patients and 2 female patients, All patients age ranged from 45 to 76 years old ( median 70 years old), All patients had clinical symptoms,including left flank pain with vomiting in 3 patients and right flank pain with vomiting in 4 cases. 4 cases with cerebral thrombosis, atrial fibrillation and hypertension, 3 cases had hypertension and diabetes.4 cases was possible of renal artery embolism diagnosed by Doppler ultrasound, renal arteries showed no abnormality, while other 3 cases had no obvious symptoms.CT test revealed low density area wedge-shaped, coated substrate edge, but no obvious occupying lesions in the pole of the kidneys.Furthermore, enhanced scan showed uneven enhancement, delayed distortion, and the lesion density below the renal parenchyma in the pole of the kidneys.Digital subtraction angiography ( DSA) were performed and the patients were given saline 20 ml and urokinase200 000 U at 15 minutes interval through indwelling catheter injection two times, followed by normal saline 20 ml and urokinase100 000 U injection once.Subsequently, the patients were given urokinase 100 000 U through the indwelling catheters infusion every four hours.Concurrently, the patients were given 6 000 U of low molecular weight heparin sodium injection subcutaneously every 12 h, as well as expansion treatment. 24 hours after the treatment, observing the infarction area by the original DSA catheter angiography.Results All patients were successfully treated.Followed up for 3 months to 7 years, 1 patient died of cerebral infarction and hypertension after 8 months, other patients were alive without evidence of renal infarction recurrence in CT examination, and condition of patients with atrial fibrillation gradually recovered. Conclusion The diagnosis of ASRI requires enhanced CT and DSA examination due to its rare incidence and the high misdiagnosis rate in clinic.Early diagnosis and use of interventional thrombolytic therapy method is a feasible and effective treatment method.