Renal Infarction in a Patient Found to Have a Dysproteinemia

A 70-year-old man with coronary artery disease, hypertension, and a history of repaired abdominal aortic aneurysm presented to the emergency room with sudden-onset abdominal pain and nausea. His blood pressure was 185/96 mm Hg with stable other vitals on presentation. Physical examination was notable for diffuse abdominal tenderness to palpation with no additional abnormalities.Laboratory investigation revealed hyponatremia (with normal plasma osmolality) and an elevated creatinine of 1.43 mg/dl (normal baseline, reference range 0.5–1.1). Complete blood count revealed leukocytosis, anemia, and thrombocytopenia. With a concern for acute intraabdominal process, abdominal computed tomography with intravenous contrast revealed “wedge-shaped” infarcts within the right kidney (Figure 1A) and a mural thrombus in the right renal artery (Figure 1B).Figure 1. (A) Abdominal CT revealing wedge-shaped infarcts within the right kidney. (B) A mural thrombus in the right renal artery. (C) Bone marrow core demonstrating hypercellular bone marrow …