SHM Converge Scientific Abstract ePoster Gallery-Renal Artery Thrombosis in Covid-19 and Anti-Phospholipid Syndrome

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This case describes a 36-year-old otherwise healthy man who presented with sudden severe right flank pain, nausea, vomiting, and upper respiratory symptoms. Initial non-contrast CT was unrevealing, and he was discharged, but he returned hours later with persistent pain. Contrast CT suggested possible renal infarction, and subsequent MRA confirmed multifocal right renal infarcts with thrombus in segmental renal artery branches, affecting nearly 90% of the kidney.<br /><br />Because diagnosis was delayed by nearly 24 hours, interventional radiology felt catheter-directed thrombolysis would carry too much risk, so he was treated conservatively and discharged on oral anticoagulation. Workup identified active COVID-19 infection and positive lupus anticoagulant antibodies, raising concern for acquired antiphospholipid syndrome (APLS) contributing to a “double-hit” hypercoagulable state. However, repeat testing 90 days later showed resolution of the APLS antibodies, with negative lupus anticoagulant testing and normal PTT-LA times.<br /><br />The report emphasizes that renal infarction is a rare but serious and often difficult diagnosis in patients with acute abdominal or flank pain because many more common conditions are considered first. Hypercoagulability is an uncommon cause of renal infarction, and APLS-related renal infarction is especially rare. Although COVID-19 is known to increase thrombotic risk, arterial thromboses are uncommon, and the role of antiphospholipid antibodies in COVID-related clotting remains uncertain.<br /><br />Overall, the case highlights the importance of early recognition of renal artery thrombosis and renal infarction, since delayed diagnosis can prevent timely intervention and leave a young patient with lifelong risks such as hypertension, reduced renal function, or dialysis.

Asset Subtitle

Richard Antoun

Meta Tag

Author List Katherine Coffey-Vega, Mousafa Zainab, Richard Antoun, Thomas S. Davis

Category Clinical Vignettes

Concept Acute Renal Infarction

Concept Renal Infarction

Concept Renal Artery Thrombosis

Concept Thromboembolic Disease

Concept Hypercoagulable State

Distinguished Non-Finalist

Presenter Organization Virginia Tech Carilion Internal Medicine

Presenting Author Richard Antoun

Track Adult

Keywords

renal infarction

right flank pain

renal artery thrombosis

COVID-19

antiphospholipid syndrome

lupus anticoagulant

hypercoagulable state

contrast CT

MRA

oral anticoagulation

Acute Renal Infarction

Renal Infarction

Renal Artery Thrombosis

Thromboembolic Disease

Hypercoagulable State