Spontaneous Rupture Of the Kidney

Joachim, Gary R.; Becker, E. Lovell

doi:10.1001/archinte.1965.03860140056012

Cited by 38 publications

(4 citation statements)

References 36 publications

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“…The increased pressure within the pelvicalyceal system generates stretching and decreased elasticity of the capsule, and soft tissue attenuation [5]. There is a higher probability for a rupture to take place in an area where the normal structure was altered by infections, tumors or scaring [21]. As described by Huang et al in pregnant women with pre-existing hydronephrosis, actions associated with sudden increase of the hydrostatic pressure in the urinary tract, like IV fluid boluses for pregnancy related surgical procedures (i.e.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Efrimescu¹

2013

Emergency Medicine

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BackgroundLoin/flank pain in pregnancy is a common presentation to the Emergency Department (ED). There are a wide range of causes: medical, surgical, urological, obstetrical and gynaecological, but the predominant cause is acute hydronephrosis [1]. Hydroureteronephrosis is frequently associated with pregnancy and on rare occasions can progress to rupture of the urinary tract. This paper describes the case of a young female who developed an initial rupture of the left ureter, progressing following admission to develop symptoms on the right side. Also we have included a narrative review of the literature on this subject. To date, we believe, this is the first case report of a patient with bilateral symptomatic upper urinary tract hydroureteronephrosis. Case PresentationA 31 year old white European primigravida (28 weeks gestational age) with an uncomplicated pregnancy presented to the Emergency Department (ED) complaining of severe progressive left flank pain. The symptoms had commenced approximately 2 hours prior, whilst travelling by train, with gradual onset of colic pain of her left groin, worsening and ascending to the left flank and renal angle. Her past medical history included an episode of left pyelonephritis four years previous, bilateral breasts reduction two years ago and mild eczema which improved with progression of her pregnancy. She had no allergies and was not on any current medication. There was no family history of significance. On examination she was alert and oriented (GCS 15/15), not pale or cyanotic, anxious, restless, and complaining of severe pain (10/10 on numeric pain rating scale). Her body temperature was normal (36.6°C), with mild tachycardia (110 bpm), BP 140/105 mmHg, respiratory rate 17 breaths/minute, SaO 2 96% on room air and a capillary refill time < 2 sec. Percussion tenderness was elicited of the left loin. Her uterus had a normal height for the gestational age; there was no vaginal discharge or bleeding. Foetal movements were present with a heart rate of 120 bpm. The remainder of the clinical exam was unremarkable. An 18 G Intravenous (IV) cannula was inserted and baseline bloods investigations drawn for full blood count, group and screen, urea and creatinine, electrolytes, glucose, liver function test's, "C" Reactive Protein (CRP) and Venous Blood Gas (VBG). She was initially managed with opioid analgesia (pethidine), intravenous paracetamol and maintenance fluids (0.9% NaCl). Shortly after her pain score subsided to 3-4/10.No free fluid or other abnormalities were revealed by an ED Ultrasound (US). A bed side urinalysis revealed a moderate amount of blood, but negative for nitrites and leukocytes. Her VBG and glucose were normal.Based on the clinical presentation and microscopic haematuria a provisional diagnosis of renal colic secondary to a possible migrant renal calculus was established.Laboratory blood results revealed an elevated WBC (14.5×10 9 /L) with mild neutrophlia (11.8×10 9 /L) and elevated CRP (8.3 mg/L). Urea, creatinine, LFT's and electrolytes were normal. P...

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Efrimescu¹

2013

Emergency Medicine

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“…Common etiological factors for urinoma development in pregnant women include renal injury or urinary tract obstruction are [12]. In pregnant women, cases of spontaneous rupture of the kidneys and renal tract rupture have been reported, but development of urinomas as a result of these is very rare [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature

Chen

Yan

Zhang

et al. 2019

BMC Pregnancy Childbirth

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Background: Spontaneous formation of urinoma is a rare condition, especially for pregnant women. We report a patient in the third trimester of pregnancy with a spontaneous renal rupture who then develops a urinoma from urine leaking into the perinephric space. Case presentation: A 23-year-old primagravida was diagnosed with a spontaneous renal rupture and acute left loin pain accompanied by hematuria when she was 35 weeks pregnant. A sub-capsular perinephric cyst then developed to a size of 319 × 175 × 253 mm, and because of discomfort to the patient, we performed Cesarean section. After a healthy male newborn was delivered, fluid was suctioned from a large perirenal cyst that had an estimated size of 300 × 200 × 300 mm. A percutaneous nephrostomy tube was left in the cyst until CT showed no remaining fluid. In the six-month follow-up, the patient showed no perirenal extravasation according to an ultrasound scan, and the urine analysis and renal function tests were normal. Conclusion: Close follow-up should be recommended for the patient who has renal rupture after conservative therapy, especially for pregnant woman. CT or MRI should be considered in addition to utilizing ultrasound in the management of pregnant women who present with urinomas. Percutaneous nephrostomy is suggested as an appropriate treatment for large urinomas.

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“…If rupture was preceded by a pyonephrosis the extravasated material may be infected. Dispersion may be limited by Gerota's capsule or involve the retroperitoneum and this may lead to fistulization into the abdominal cavity [4]. Abeshouse et al remarked that spontaneous pelvic rupture practically always occurs in a kidney which is seat of chronic pylonephritis or where there is dilatation secondary to obstruction [5].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report

et al. 2011

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Seventeen cases of peritonitis due to rupture of a pyonephrosis have been reported. The majority of these cases occur secondary to renal stones. Only two cases of ruptured pyonephrosis with concurrent kidney neoplasm have been described and only one of these presented as an acute peritonitis. In this presentation we discuss an unusual case of a 68 year old man with a chronic history of bilateral nephrolithiasis and recent pyonephrosis. He presented acutely with peritonitis and was later found to have a carcinosarcoma of the kidney. The case highlights the importance of recognizing the possibility of underling renal carcinoma in patients presenting with a ruptured pyonephrosis and discuss steps to avoid this serious complication.

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Spontaneous Rupture Of the Kidney

Cited by 38 publications

References 36 publications

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Spontaneous Non-traumatic Upper Urinary Tract Rupture in Pregnancy: Case Report and Literature Review

Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature

Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report

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