Infarto renal como causa infradiagnosticada de dolor abdominal
Acute renal infarction as a cause of abdominal pain is rare, though its frequency is increasing along with atherosclerotic disease. Given that underdiagnosis is often a problem, it is important to bear this diagnosis in mind whenever a patient presents with abdominal and flank pain, an elevated lact...
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| Published in: | Emergencias Vol. 22; no. 2; pp. 117 - 119 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | Spanish |
| Published: |
Saned
2010
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Acute renal infarction as a cause of abdominal pain is rare, though its frequency is increasing along with atherosclerotic disease. Given that underdiagnosis is often a problem, it is important to bear this diagnosis in mind whenever a patient presents with abdominal and flank pain, an elevated lactate dehydrogenase level, and abnormal sediment in urine.
When radiologic and ultrasound images of the abdomen are normal and no signs suggest urinary tract obstruction, contrast-enhanced computed tomography (CT) would be indicated to confirm the diagnosis; this noninvasive examination is useful because the effectiveness of treatment is time-dependent. We report the case of a woman with nonspecific abdominal pain and the aforementioned abnormal laboratory findings. CT images were diagnostic. Fibrinolytic therapy was not indicated and treatment with anticoagulants (low molecular weight heparin at therapeutic dosages) was started. The patient's condition worsened, however, and she died a few days later. El infarto renal agudo es una causa poco frecuente de dolor abdominal, si bien es una patología que va en aumento (en concordancia con la patología arteriosclerótica) y no en pocas ocasiones está infradiagnosticada. Por ello es importante pensar en ella en todo paciente con dolor abdominal en flanco, aumento de la láctico deshidrogenada (LDH) y alteraciones en el sedimento; si las pruebas radiológicas y la ecografía abdominal son normales, sin imágenes que nos sugieran uropatía obstructiva, la realización de una tomografía computarizada (TC) con contrate (prueba no invasiva) estaría indicada para confirmar el diagnóstico, dado que la efectividad del tratamiento es tiempo dependiente. Presentamos el caso clínico de una paciente con dolor abdominal inespecífico con las alteraciones analíticas anteriormente mencionadas, en la que la Te abdominal fue diagnóstica. No había indicación de tratamiento fibrinolítico, por lo que se inició tratamiento anticoagulante con heparinas de bajo peso molecular (HBPM) a dosis terapéuticas. A pesar de ello la paciente evoluciona desfavorablemente falleciendo días después. |
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| ISSN: | 1137-6821 |