Background: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal haemorrhage, specifically in cases of non-iatrogenic origin. Methods: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg Hospital. Results: Renal artery embolisation was performed in a total of 92 patients. The indication was traumatic renal injury in 60 patients (65.2%), with mean age 28.2 years. The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%). Digital subtraction angiography (DSA) showed pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%. Embolisation success: 85% after one, 88.9% after a second attempt, with an overall success rate of 98.3% after two attempts. In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%). Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%). Embolisation was repeated in 16.3%, with eventual success rate of 93.8%. Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases. Of the 9 patients who returned for follow-up with renogram imaging, 4 had a differential function of > 20% of the embolised kidney. Conclusion:Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from trauma, malignancy, iatrogenic or other causes.

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We describe a 22-year old female who presented with a 5-year history of a palpable, painless mass in the right flank. Computerized tomography demonstrated a solid renal mass measuring 18 cm × 13 cm with peripheral calcification, areas of vascularity and necrosis. The appearance suggested renal cell carcinoma or nephroblastoma, but percutaneous renal biopsy suggested an adrenal origin. At right radical nephrectomy, the adrenal gland was completely normal. Histology showed sheets and nests of epithelioid cells with abundant eosinophilic to clear cytoplasm, confirming a diagnosis of epithelioid angiomyolipoma (EAML), a rare mesenchymal tumor belonging to the perivascular epithelioid cell tumor family (PEComas). At 33 months followup, there was no evidence of recurrence or metastases.

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