Asymptomatic renal infarction after left upper lobectomy: Case report

Nozomu Motono; Masahito Ishikawa; Shun Iwai; Yoshihito Iijima; Hidetaka Uramoto

doi:10.1016/j.ijscr.2021.106254

Asymptomatic renal infarction after left upper lobectomy: Case report

Int J Surg Case Rep. 2021 Aug:85:106254. doi: 10.1016/j.ijscr.2021.106254. Epub 2021 Jul 31.

Authors

Nozomu Motono¹, Masahito Ishikawa², Shun Iwai³, Yoshihito Iijima⁴, Hidetaka Uramoto⁵

Affiliations

¹ Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. Electronic address: motono@kanazawa-med.ac.jp.
² Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. Electronic address: masa-i@kanazawa-med.ac.jp.
³ Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. Electronic address: mhg1214@kanazawa-med.ac.jp.
⁴ Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. Electronic address: y-iijima@kanazawa-med.ac.jp.
⁵ Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. Electronic address: hidetaka@kanazawa-med.ac.jp.

Abstract

Background: Renal infarction after pulmonary resection is relatively rare; however, it is associated with severe morbidity.

Case presentation: An 80-year-old woman without any severe comorbidity or smoking history underwent left upper lobectomy (LUL) concomitant with mediastinal lymph node dissection for lung adenocarcinoma. She did not show fever, flank pain, and/or nausea; however, laboratory data revealed an elevated white blood cell count (WBC) (13,460 cells/mm³) and elevated serum lactate dehydrogenase (LDH) (670 IU/L) and C-reactive protein (CRP) (23.6 mg/dL) levels on the fifth postoperative day. Contrast-enhanced computed tomography from the thorax to the pelvic cavity revealed a partial defect of the right kidney without any indication of infection and no pulmonary vein stump thrombosis. We diagnosed the patient with partial right renal infarction, and heparin (10,000 IU/day) was initiated. Laboratory data showed gradual reduction in the WBC (7700 cells/mm³), as well as in the serum LDH (355 IU/L) and CRP (0.76 mg/dL) levels, 7 days after heparin initiation. Anticoagulation therapy including heparin administration was discontinued because renal function remained, and we observed no pulmonary vein stump thrombosis. Laboratory data remained within normal limits, and the patient was discharged on postoperative day 15.

Conclusions: LUL is considered a risk factor for this condition, and elevated WBC, as well as serum LDH and CRP levels are useful diagnostic indicators.

Keywords: Anticoagulation therapy; Left upper lobectomy; Renal infarction; Thrombus.