A Rare Case of Spontaneous Bilateral Subcapsular Renal Hematoma

Abstract

Spontaneous bilateral renal subcapsular hematoma is a rare condition. On literature review, only 2 case reports have elucidated possible etiologies for such a presentation; however, no definite conclusions have been made. We present a rare case of a 52-year-old female with diabetes mellitus type 2, chronic kidney disease stage 4, hypertension, hyperlipidemia, prior traumatic brain injury via motor vehicle accident, who presented to our hospital with diabetic ketoacidosis and clinical signs of pyelonephritis; subsequently, imaging demonstrated spontaneous bilateral renal subcapsular hematoma. Risk factors for the rare presentation in this patient included pyelonephritis, history of bilateral ureteral stent placement, and a remote history of a mild unilateral renal laceration secondary to a motor vehicle accident. Typically, patients with this condition achieve spontaneous resolution with conservative management. Our patient initially presented with diabetic ketoacidosis and pyelonephritis but gradually developed retroperitoneal bleeding and hemorrhagic shock. Our patient’s critical condition required close monitoring in an intensive care unit and a more invasive approach including unilateral left renal artery embolization followed by a unilateral left nephrectomy. The patient ultimately recovered and continued to be followed outpatient without any serious long-term complications.

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient

“…Other proposed risk factors that have been described are anticoagulation, antiplatelet drugs, non-steroidal anti-inflammatory drugs, hypertension, and blood dyscrasia [ 3 , 5 ].…”

“…In older series, nephrectomy is recommended above all options due to the high frequency of malignancies found among excised kidneys [ 2 ]. However, in scenarios of hemodynamic instability such as our patient, active management is preferred [ 3 ]. To our knowledge, spontaneous SRH is a rare entity and appears to be more common among chronic hemodialysis patients even without anticoagulation.…”

“…There is also a high prevalence of comorbidities such as diabetes mellitus and systemic arterial hypertension in our population. Other proposed risk factors that have been described are antiplatelet drugs, non-steroidal antiinflammatory drugs, hypertension, and blood dyscrasia [3,5].…”

“…Subcapsular renal hematomas (SRH) are rare and usually trauma-related [ 1 ]; however, spontaneous presentation occurs mainly in patients with malignancies, vasculitis, infection, or hemodialysis [ 2 , 3 ]. Traditionally, spontaneous SRH present as abdominal pain, hematuria, and other signs of bleeding [ 4 ].…”