Abstract
INTRODUCTION: Renal infarction is a rare ischemic event, occurring in 0.004-0.007% of emergency room admissions, with global renal infarction being extremely rare and caused by the blockage of the main renal artery or its branches, often due to emboli from the heart or in situ thrombosis, leading to renal ischemia. We present a rare case of complete renal infarction, highlighted not only by its coincidence with ischemic stroke and hypertensive heart disease, but also by its rapid progression to acute renal failure and cardiac arrest, despite aggressive medical management. CASE PRESENTATION: A 72-year-old female patient, known to be hypertensive with a history of hypertensive heart disease and ischemic stroke, discontinued her follow-up two months prior to her presentation at the emergency department. She presented with a dry, intermittent cough and shortness of breath of five days' duration. She was admitted with a diagnosis of severe community-acquired pneumonia and started on antibiotics, intranasal oxygen, and analgesics. Subsequently, she developed severe right-sided loin pain and vomiting, along with persistent shortness of breath. A contrast-enhanced chest computed tomography scan was performed to rule out acute pulmonary thromboembolism due to her persistent shortness of breath, which incidentally revealed a globally unilateral right renal infarction secondary to renal artery thrombosis. Despite initiating unfractionated heparin, warfarin, and supportive therapies, the patient unfortunately passed away 19 days after admission. CONCLUSION: Unilateral global renal infarction in a patient with hypertensive heart disease and ischemic stroke, though rare, can present with pronounced symptoms of acute renal failure and ultimately cardiac arrest. Prompt recognition and management of risk factors, including hypertension and previous thromboembolic events, are crucial for preventing fatal outcomes.