tiny renal infarct, normal renal function, no evidence of clotting, anticoagulation?

[DrMetal]

abd pain, CT A/P picks up a tiny renal infarct, completely normal renal function, good UOP (has a distant history of stones, but non currently...UA totally clean). Would you put him on anticoagulation? (no other evidence of any other clotting process, D-Dimer negative).

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[InvestingDoc]

abd pain, CT A/P picks up a tiny renal infarct, completely normal renal function, good UOP (has a distant history of stones, but non currently...UA totally clean). Would you put him on anticoagulation? (no other evidence of any other clotting process, D-Dimer negative).

In my mind this raises the question if a fib is present. Why did this happen?

Personally I'd send to cards for 30 day monitor no different than stroke and I would do anticoag workup if kidney function is normal.

How did you get insurance to approve a CT A/P with contrast? They almost always decline it for me without an ultrasound first or just a CT without contrast.

 

[DrMetal]

In my mind this raises the question if a fib is present. Why did this happen?

Personally I'd send to cards for 30 day monitor no different than stroke and I would do anticoag workup if kidney function is normal.

How did you get insurance to approve a CT A/P with contrast? They almost always decline it for me without an ultrasound first or just a CT without contrast.

CT was done in the ER, of course.

its a young kid (early 20s), no h/o cardiac pathology, stone normal EKG, no h/o palpitations. I think the anticoagulation is a little aggressive. Doesn't the negtive D-dimer give some reassurance? Also cant tiny infarcts occur in the kidney randomly, unrelated to a clotting process?

 

[gutonc]

Forget this ever happened.

Please don’t anticoagulate this kid. What’s your endpoint on that? 3 months? 6 months? Lifelong?

 

[DrMetal]

Forget this ever happened.

Please don’t anticoagulate this kid. What’s your endpoint on that? 3 months? 6 months? Lifelong?

I totally agree. someone else was suggesting it. thanks for the sanity check.

 

[jdh71]

I totally agree. someone else was suggesting it. thanks for the sanity check.

plus just because it appears like a renal infarct on CT doesn’t mean it’s a renal infarct

if he has something weird actually going on it’s going to need to declare itself further

 

[Animalcules]

Make sure not APS given age

 

[DrMetal]

agree to all of the above, thanks guys. I stopped the crazy train.