Reversible acute anuric kidney injury after surgical evacuation of perinephric hematomas as a complication of renal transplant biopsies

Abstract

Percutaneous renal transplant biopsy is the gold standard investigation to diagnose the cause of renal allograft dysfunction. There are inherent risks to this investigation, despite the procedure becoming safer due to the increased utilization of ultrasound-guided techniques. These biopsy risks can be increased when there is acute rejection present with a swollen transplanted kidney. Subcapsular hematomas are not uncommon after percutaneous renal transplant biopsies, but we describe two cases of post-biopsy subcapsular hematoma which were associated with acute renal allograft dysfunction in pediatric renal transplant recipients who did not have acute rejection.

Page Kidney Phenomenon following Kidney Graft Biopsy

“…In our experience, Doppler US is a useful modality for prompt diagnosis in the setting of percutaneous kidney graft biopsy. The absence or reversal of diastolic blood fl ow with elevated resistance index is a specifi c feature of Page kidney phenomenon although differential diagnoses also include acute tubular necrosis, acute rejection and renal vein thrombosis [3].…”

“…Most common complications are minor and can be managed conservatively. Major complications can occur in about 1% of cases [3,4], which may require blood transfusion, interventional procedure or even surgical exploration. Page kidney phenomenon is one of the rare but serious complications, in which the renal parenchyma is tamponade and its perfusion is compromised as a result of haematoma formation under the renal capsule.…”

Page kidney after pediatric kidney transplantation: a case report

“…The Page kidney (PK) phenomenon refers to any extra-renal process causing significant compression of the renal parenchyma and leading to hypoperfusion and ischemia with subsequent activation of the renin-angiotensin-aldosterone axis (RAAS) (1)(2)(3)(4) . Onset of hypertension shortly after the causative event constitutes the main symptom in patients without renal failure.…”

Perinephric hematoma induced by factor Xa inhibitor in a patient with a vascular renal mass

“…These bleeds are classically described to present in the form of Lenk's triad with acute flank pain, flank mass and hypovolemic shock. [1] Whilst some of these hematomas are reported to occur spontaneously, [1] secondary causes such as renal tumors, [2] the use of anticoagulant therapy [3] and procedural complications of renal biopsy [4] are also frequently reported. Amongst renal tumors, angiomyolipomas and renal cell carcinomas are known to be most frequently associated with perinephric hematomas.…”