Global renal infarction from main renal artery occlusion in under-anticoagulated atrial fibrillation: A case report

Renal artery thrombosis is a rare medical emergency that has severe, possibly life-threatening consequences, including global renal infarction and rapid decrease in kidney function. Renal artery thrombosis may often be attributed to cardioembolic events, perhaps secondary to underlying atrial fibrillation (AF), though presentation with complete occlusion of the main renal artery resulting in global renal infarction is rare. A 47-year-old man with paroxysmal AF not on anticoagulation, heart failure with improved ejection fraction, and hypertension presented with acute abdominal pain, nausea, and vomiting. CT imaging revealed a complete right renal artery occlusion that had resulted in global renal infarction. Management included percutaneous thrombectomy with partial thrombus removal and systemic anticoagulation. Extensive workup failed to demonstrate other known etiologies of renal infarction besides cardioembolic in the setting of AF. After intervention, overall kidney function remained stable, but right renal function was significantly reduced as demonstrated with technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renogram. The potential for renal artery thrombosis presenting with nonspecific abdominal symptoms should be considered in patients with AF who are not receiving appropriate anticoagulation. Patients should undergo urgent CT angiography imaging and intervention for optimal outcomes. These findings support the importance of appropriate anticoagulation or left atrial appendage occlusion in AF.