Wunderlich syndrome: spontaneous atraumatic rupture of the kidney

Abstract

Atraumatic spontaneous retroperitoneal haemorrhage is a distinct clinical entity with potentially life-threatening complications. The commonest aetologies include ruptured aortic or visceral aneurysm, spontaneous rupture of the kidney and patients with coagulopathies. Spontaneous rupture of the kidney can occur due to underlying renal pathologies such as malignancy, angiomyolipoma, vascular malformation, vasculitis and infection. Approximately 5% of such cases occur without an identifiable renal pathology and are termed as 'idiopathic'. Idiopathic spontaneous rupture has been described among patients on chronic haemodialysis associated with acquired cystic disease of the kidney. We describe the extremely rare instance of a patient with a failed renal allograft and recently started on haemodialysis who suffered an idiopathic spontaneous rupture of his native kidney.

The incidence and risk factors of unplanned removal of peripherally inserted central catheters among adult patients: A multi‐centre cohort study

“…Importantly, we found five risk factors that are modifiable, including with thrombosis history, higher BMI, PICC insertion due to infusion failure, double-lumen catheter and valved catheter. As mentioned above, thrombosis is a frequent complication and reported closely related to unplanned removal of PICCs (Gunawansa et al, 2018;Pu Yingna et al, 2022), and thromboembolic complications were especially common among persons with a past history (Lobo et al, 2009). In terms of BMI, a number of studies support a connection between obesity and thrombosis, involving elevated expression of the prothrombotic molecules plasminogen activator inhibitor-1 and tissue factor and increased platelet activation (Samad & Ruf, 2013).…”

“…Among the six risk factors, the female sex is the only unmodifiable risk factor. Increased incidence in females might be due to a smaller blood vessel inner diameter, as well as a higher fibrinogen level (Li et al, 2018), leading to a lower blood flow rate and a higher incidence of thrombosis, a frequent catheter-related complication resulting in catheter dysfunction (Gunawansa et al, 2018), when compared with males (Nifong & McDevitt, 2011). Despites not being supported by previous evidence, our result suggests that the potential significance of FIB-lowering regimens and handgrip exercise to enlarge inner diameter and increase blood flow rate within females with PICCs (Sijuan et al, 2013).…”