Renal Infarction Mimicking Renal Colic: A Diagnostic Challenge

Abstract

Background: Renal infarction is an uncommon but clinically important cause of acute flank pain and may closely resemble renal colic, particularly when nephrolithiasis is simultaneously present. Because renal colic is considerably more common, vascular causes of flank pain may be overlooked, resulting in delayed diagnosis and potential loss of renal function.
Case presentation: R.F is a male health patient. This case describes a patient presenting with acute flank pain and laboratory findings initially compatible with renal colic. Investigations demonstrated microscopic hematuria, acidic urine, uric-acid crystalluria, elevated serum uric acid, and increased 24-hour urinary uric-acid excretion, supporting the presence of uric-acid nephrolithiasis. However, additional abnormalities, including markedly elevated lactate dehydrogenase, increased C-reactive protein and erythrocyte sedimentation rate, and mild impairment of renal function, raised suspicion of an associated ischemic renal process. Contrast-enhanced computed tomography revealed a renal perfusion defect consistent with renal infarction, while imaging findings also supported concomitant renal stone disease. Liver function tests, lipid profile, coagulation parameters, and glycemic indices remained within normal limits.
Discussion: The coexistence of renal infarction and nephrolithiasis can complicate diagnostic interpretation because both conditions may present with flank pain and hematuria. Elevated lactate dehydrogenase and characteristic contrast-enhanced CT findings are particularly useful in distinguishing renal infarction from uncomplicated renal colic.
Conclusion: Renal infarction should be considered in patients with acute flank pain when clinical severity, laboratory abnormalities, or imaging findings are not fully explained by nephrolithiasis. Early recognition and appropriate imaging are essential to minimize diagnostic delay and preserve renal function.