Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: a single tertiary center experience

Elbaset, M. A.; Zahran, Mohamed H; Elbaz, Rizk; Badawy, Mohamed A.; Osman, Yasser

doi:10.1007/s11255-019-02333-9

Cited by 14 publications

(13 citation statements)

References 20 publications

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“…As illustrated in this case, patients with active hemorrhage on presentation appear more likely to demonstrate continued or recurrent bleeding resulting in progressive pain from distention of the renal capsule or surrounding fascia, hypertension related to Page kidney, or the sequelae of hemorrhagic shock. Selective renal artery embolization is a minimally invasive procedure, as compared to nephrectomy, with an extremely low risk to the patient and results in significantly improved renal function relative to conservative therapy [ 8 ]. Therefore, it seems the logical choice for initial management in this circumstance.…”

Section: Discussionmentioning

confidence: 99%

“…However, it should be noted that conservative treatment comes at the cost of decreased renal function compared to other courses of treatment. Selective arterial embolization is another method to control active bleeding, particularly in hemodynamically unstable patients [8]. Many authors recommend embolization as the definitive therapy given strong evidence supporting its efficacy in cases of both traumatic and non-traumatic renal hemorrhage and relatively low-risk profile [6,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Renal Hemorrhage: A Case Report and Clinical Protocol

Antonescu¹,

Duhamel²,

Giacinto³

et al. 2021

Cureus

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Spontaneous renal hemorrhage is an uncommon entity with potentially serious consequences. We present a 68-year-old female with a three-day history of progressively worsening left-sided flank pain due to spontaneous left renal hemorrhage without a history of trauma or anticoagulation. The patient's symptoms improved with conservative management and she was discharged after several days of observation. However, the patient was readmitted the next day with progressively worsening pain due to hematoma expansion from active extravasation. On the second admission, interventional radiology successfully embolized the affected vessels and the patient improved rapidly. The hematoma decreased in size on followup exams but no etiology was discovered. Early arterial embolization may have improved outcomes in this case and we argue that it should be considered early in the management of all patients with spontaneous renal hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spontaneous Renal Hemorrhage: A Case Report and Clinical Protocol

Antonescu¹,

Duhamel²,

Giacinto³

et al. 2021

Cureus

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“…Discontinuation of anticoagulants and replacement of blood volume with close monitoring of vital signs and hemoglobin levels are sensible first-line treatments for patients who are hemodynamically stable [7] . With the improvement in non-invasive vascular procedures, the current primary treatment for unstable patients is TAE or curative nephrectomy if embolization fails [11,12] . Embolization procedures for renal vascular lesions performed with platinum microcoils had shown successful outcomes without major complications, such as large renal parenchymal infarction or iatrogenic morbidity [13] .…”

Section: Discussionmentioning

confidence: 99%

“…[7] With the improvement in non-invasive vascular procedures, the current primary treatment for unstable patients is TAE or curative nephrectomy if embolization fails. [11,12] Embolization procedures for renal vascular lesions performed with platinum microcoils had shown successful outcomes without major complications, such as large renal parenchymal infarction or iatrogenic morbidity. [13] In 2018, Xie et al [8] reported 3 patients with spontaneous perirenal hemorrhage who were treated successfully with gelatin sponge embolization.…”

Section: Discussionmentioning

confidence: 99%

Bilateral spontaneous massive renal hemorrhage in a peritoneal dialysis patient

et al. 2021

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Rationale:Non-traumatic bilateral spontaneous massive renal hemorrhage confined to the subcapsular and perirenal space, also known as Wünderlich syndrome, can occur suddenly and insidiously and cause serious consequences if not properly identified and managed. We report a case of bilateral spontaneous massive renal hemorrhage in a series of devastating episodes.Patient concerns:A 38-year-old woman undergoing peritoneal dialysis for 7 years for end-stage renal disease presented with disturbances in consciousness and sudden hypotension.Diagnosis:The patient's laboratory results indicated an abrupt drop in hemoglobin level. Emergent abdominal computed tomography (CT) showed a rupture of the lower pore of the left kidney, with massive hemoretroperitoneum. A second sudden reduction in hemoglobin level occurred 2 months later during the same admission course, with poor response to urgent blood transfusion. Contrast extravasation at the lower pole of the right kidney and posterior pararenal space along with a subcapsular hematoma was revealed on abdominal CT.Intervention:The patient's initial episode was managed with emergent transcatheter arterial embolization (TAE) of the left renal artery and again after the second episode for occlusion of the inferior branches of the right renal artery.Outcomes:After the first episode, immediate postprocedural angiography showed total occlusion of the left renal artery without contrast extravasation. Follow-up CT performed 10 days after the first TAE showed a residual left perirenal hematoma that extended to the left retroperitoneal and left upper pelvic region, without active bleeding. No follow-up imaging was done after the second TAE except for immediate postprocedural angiography, which showed no additional contrast extravasation of the right renal artery.Lessons:Bilateral spontaneous massive renal hemorrhage is rare and generally occurs in patients undergoing dialysis. Known studies appear primarily in case reports. Most patients can be treated successfully with TAE when diagnosed early.

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“…or angiomyolipoma. Renal neoplasms are the most common cause of SRH, accounting for up to 65% of all cases [2,3] . Patients with SRH may present with insidious-onset flank pain, a palpable flank mass, and hypovolemic shock; these are known as 'Lenk's triad' and are associated with retroperitoneal haematoma [1] .…”

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confidence: 99%