Acute renal infarction as an unusual presentation of hypertensive crisis in an elder female patient: a case report and literature review.

Introduction and importance: Acute renal infarction is a rare condition characterized by the obstruction of renal arteries, leading to ischemia and infarction of the renal tissue. It is often underdiagnosed and can present with acute abdominal pain. Case presentation: A 70-year-old female with a 1-year history of hypertension presented to the emergency room with severe sharp flank pain and vomiting of 8 hours duration. She had no comorbidities and was taking Amlodipine 10 mg for hypertension. Vital signs revealed severely elevated blood pressure (230/180 mmHg) and a pulse rate of 98 bpm. Clinical examination showed tenderness over the right kidney without signs of abdominal guarding. Renal function was normal, and there were no signs of systemic inflammation. Imaging studies, including abdominal ultrasound and contrast-enhanced CT, confirmed the diagnosis of unilateral renal infarction. Clinical discussion: A multidisciplinary team, including Internal Medicine, Cardiovascular Surgery, Urology, and Interventional Radiology, convened to discuss the treatment approach. Considering the duration of symptoms and the preserved renal parenchyma, revascularization was not pursued. The patient was admitted and started on therapeutic dose low molecular heparin for anticoagulation. Blood pressure was controlled using intravenous Labetalol. The patient showed significant clinical improvement and was discharged on apixaban and Amlodipine. Follow-up lab tests after 1 month demonstrated normal kidney function. Conclusion: This case highlights the importance of considering renal infarction in the differential diagnosis of acute abdominal pain, especially in hypertensive patients. Early recognition and appropriate management are crucial for preventing complications and preserving renal function.