Title : Idiopathic renal infarction in a young adult with isolated nicotine vaping exposure following extensive negative thrombotic evaluation
Abstract:
Background: Renal infarction is a rare and frequently overlooked clinical entity, often presenting with non-specific abdominal symptoms that mimic more common intra-abdominal pathology, resulting in delayed recognition. The condition is typically associated with cardioembolic disease, inherited or acquired thrombophilia, vasculitis, and vascular abnormalities. Cases occurring in young adults without identifiable risk factors are uncommon and present a diagnostic challenge. Electronic cigarette use has recently emerged as a potential contributor to endothelial dysfunction, oxidative stress, and platelet activation, although evidence linking vaping to clinically significant arterial thrombotic events remains limited.
Case Presentation: A 26-year-old man with a background history of asthma presented with acute abdominal pain initially central in distribution before localising to the right flank and right iliac fossa, associated with repeated episodes of vomiting. He denied urinary symptoms, trauma, previous thrombotic events, or significant urological history. Initial biochemical investigations demonstrated a markedly elevated lactate dehydrogenase level (1755 U/L), elevated inflammatory markers (CRP 92 mg/L), and preserved renal function (creatinine 109 µmol/L; eGFR 77–80 mL/min/1.73m²). Contrast-enhanced CT imaging identified a right upper-pole partial renal infarction without evidence of renal artery stenosis or major vascular abnormality. Comprehensive investigations were initiated to evaluate underlying causes, including thrombophilia screening, antiphospholipid antibody testing, vasculitis screening, homocysteine levels, JAK2 mutation analysis, paroxysmal nocturnal haemoglobinuria screening, and genetic assessment. No conventional thrombotic or vascular aetiology was identified during evaluation. Social history was notable for regular nicotine-containing electronic cigarette use (approximately 5–6 inhalations ten times daily), representing the only identifiable potential prothrombotic exposure.
Discussion: Idiopathic renal infarction in young patients remains uncommon and necessitates systematic investigation to exclude embolic, vascular, autoimmune, and hypercoagulable causes. Experimental and epidemiological studies increasingly suggest nicotine-containing vaping may induce endothelial injury and a prothrombotic state through platelet activation and vascular dysfunction. Although a causal relationship cannot be inferred from a single case, the absence of alternative risk factors raises the possibility of an association warranting further investigation.
Conclusion: This case emphasises the importance of considering renal infarction in young patients presenting with acute abdominal or flank pain and disproportionately elevated LDH levels. It additionally highlights nicotine vaping as a possible emerging thrombotic exposure requiring further study. Keywords: Renal infarction; Electronic cigarette; Nicotine vaping; Arterial thrombosis; Hypercoagulable state; Acute flank pain
