Bilateral renal infarction secondary to paradoxical embolism

Paradoxical embolism is an uncommon but increasingly reported cause of arte rial embolic events. Involvement of the kidney is rarely reported. Autopsy studies suggest, however, that embolic renal infarction is underdiagnosed a ntemortem. We report a case of bilateral, main renal artery occlusion and a cute renal failure secondary to paradoxical embolism. Clinical and laborato ry data at presentation were not suggestive of renal infarction. Support fo r the diagnosis of paradoxical embolism, which most commonly occurs across a patent foramen ovale, was made by contrast echocardiography, which provid es a sensitive method for detecting right-to-left intracardiac shunts. The often subtle presentation of renal infarction suggests patients with periph eral or central arterial embolic events should be carefully observed for oc cult renal involvement. Contrast echocardiography should be performed when renal infarction occurs without a clear embolic source to evaluate for para doxical embolism. (C) 1999 by the National Kidney Foundation, Inc.