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Renal infarction and renal-vein thrombosis

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2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Sudden flank or abdominal pain with a solitary functioning kidney, bilateral arterial infarction, rapidly rising creatinine, anuria, shock, uncontrolled hypertension, transplant dysfunction or extension of renal-vein thrombus into the inferior vena cava requires immediate renal, vascular, urological and interventional-radiology assessment after ABCDE stabilisation.

Synopsis

Distinguish arterial renal infarction from renal-vein thrombosis, obtain time-sensitive vascular imaging, preserve threatened renal tissue and select anticoagulation or intervention according to cause, kidney function and bleeding risk.

  • Renal infarction is acute loss of arterial perfusion from embolism, in-situ thrombosis, dissection, trauma or a hypercoagulable state; atrial fibrillation is a classic embolic source.
  • The usual arterial presentation is abrupt unilateral flank or abdominal pain, nausea and new hypertension with microscopic haematuria, proteinuria and a disproportionately raised LDH, but these findings are not individually diagnostic.
  • A normal non-contrast renal-colic CT can miss infarction. If clinical suspicion persists, obtain contrast-enhanced CT with an arterial phase or CT angiography urgently unless another modality is selected by radiology.

Key red flags

Arterial embolic infarction

Abrupt flank or upper abdominal pain occurs in a patient with atrial fibrillation, recent myocardial infarction, valvular disease, endocarditis or another systemic embolus, with haematuria and new hypertension possible.

Investigation priorities

01
FBC, creatinine, electrolytes, LDH, liver profile and CRPFirst step

Measure renal impact, anaemia, thrombocytopenia, inflammation and the tissue-injury signal that supports infarction.

Management branches

Acute arterial suspicionDo not stop at renal-colic imaging

Sudden flank pain, embolic risk, high LDH or new hypertension persists without an explanatory stone.

  1. Stabilise, document exact symptom onset, give kidney-safe analgesia and send renal, blood-count, coagulation, LDH, urine and pregnancy tests without postponing definitive imaging.
  2. Ask radiology for urgent contrast-enhanced arterial imaging to define main or branch occlusion, infarct extent, dissection and viable parenchyma.

Key medicines

Unfractionated or low-molecular-weight heparinUse a therapeutic weight-based local protocol, choosing agent and adjustment from current creatinine clearance and bleeding risk.
Vitamin K antagonistStart warfarin with parenteral anticoagulation for at least five days and until therapeutic INR criteria are met under local policy.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom