急性腎梗塞之診斷與處理

Diagnosis and Management of Acute Renal Infarction

急性腎臟梗塞因其罕見性及非特異性診斷而不容易診斷。此病例報告描述一個在家庭醫學科門診以腰痛、噁心、嘔吐及不規則心音為表現，經緊急電腦斷層診斷，之後住院以靜脈肝素（heparin）及口服抗凝血劑（warfarin）成功治療的案例。雖然腎臟血管攝影並未發現明顯血栓，但腎臟掃描攝影（dimercaptosuccinic acid, DMSA）確實顯現不可逆的腎臟損傷。因此，對於高危險性族群（例如心房震顫），別忘了此診斷，才能及早安排檢查，避免之後不可逆的腎功能受損。而若欲避免急性腎臟梗塞造成之腎功能損壞，血栓溶解術（thrombolysis）或許是個理想的治療方式；然而，對此情形之最佳治療方式，至今仍有爭議，需要後續大型、隨機的臨床試驗才能進一步達成共識。

Acute renal infarction is challenging to diagnose due to the nonspecific symptoms and rarity of the condition. This report describes a case of acute renal infarction presented in the family medicine clinic presented with flank pain, nausea, vomiting and irregular heart rate. Diagnosed by emergent computer tomography and then is admitted for further treatment with intravenous heparin and oral warfarin. Although renal angiography showed no evidence of a thrombus, irreversible renal damage did exist based on dimercaptosuccinic acid (DMSA) scintigraphy. We should always keep the diagnosis in mind to avoid irreversible kidney function destruction, especially in the high risk group (such as atrial fibrillation). Thrombolysis may be an ideal therapy for preventing renal function deterioration in cases of acute renal infarction.