Renal Rupture Research Articles

Clinical case. Focal form of xanthogranulomatous pyelonephritis, complicated by spontaneous renal rupture

Clinical case. Focal form of xanthogranulomatous pyelonephritis, complicated by spontaneous renal rupture

Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report

BackgroundSpontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus is a rare urinary system disease. Prenatal ultrasound diagnosis presents challenges due to the lack of specific clinical features.Case presentationA 27-year-old Chinese woman gravida 2 para 0 found her fetus with the left Wunderlich syndrome accompanying bilateral hydronephroses and bladder dysfunction with an early diagnosis through prenatal ultrasound and postnatal magnetic resonance imaging. After a timely emergency cesarean section, the infant was administrated antimicrobial prophylaxis and an indwelling catheter treatment. Ultrasound follow-up showed his urinary system gradually developed normally.ConclusionA fetus with bilateral hydronephroses accompanying bladder dysfunction should be observed because of the risk of spontaneous renal rupture with hemorrhage formation. Ultrasound and magnetic resonance imaging play a vital role in the diagnosis and follow-up of Wunderlich syndrome. Early diagnosis facilitates better pregnancy planning and appropriate care of newborns.

Management of Post-nephrectomy Delirium in Patients with Traumatic Renal Rupture: A Case Report

Management of Post-nephrectomy Delirium in Patients with Traumatic Renal Rupture: A Case Report

Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report.

Wunderlich syndrome is a rare and possibly life-threatening haemorrhagic syndrome presenting as spontaneous nontraumatic renal rupture with subcapsular and perinephric haemorrhage. Apixaban, a direct oral anticoagulant recommended in patients with atrial fibrillation, has previously been associated with atraumatic solid organ rupture but, to date, no case of apixaban-related Wunderlich syndrome has been reported. We report a rare case of Wunderlich syndrome associated with apixaban while addressing the difficulties face by clinicians when managing anticoagulation in bleeding patients.

Spontaneous Renal Rupture and Hematoma in a Covid - 19 Case

Spontaneous Renal Rupture and Hematoma in a Covid - 19 Case

Traditional massage therapy-induced traumatic rupture of hydronephrosis secondary to ureteral obstruction: a case report

Introduction: The vast majority of renal injuries occurred by blunt mechanisms with fall and motor vehicle crashes. Massage therapy is widely used as traditional medicine and has been viewed as a safe treatment tool without major complications or side effects. Renal rupture due to traditional massage therapy is a rare complication. Moreover, it occurs even less commonly considering the anatomical location of the kidneys, where they are well-protected. The purpose of this article is to present a case of a patient with an acute ruptured kidney due to traditional massage therapy four hours before admission to the hospital. Case description: A 52-years-old man came to the emergency department with right upper and lower abdominal pain. The pain began in the flank region and spread to the right lower abdomen. He visited a traditional massage therapist and received massage therapy in the abdominal and back region with no history of other trauma or other activities before admission. The hemodynamic status was unstable. Physical examination revealed tenderness in the right upper and lower abdominal region and bulge area at the right flank region. We performed an emergency laparotomy due to hemodynamic instability. Right retroperitoneal exploration revealed active bleeding from a ruptured right kidney. Thus right nephrectomy was performed. Post-operative non-contrast CT scan showed ureteral obstruction due to the presence of right distal ureteral stone Conclusion: Kidneys with anatomical abnormalities such as hydronephrosis and blunt abdominal trauma may increase pressure in the hydronephrotic renal pelvis and cause a rupture. We suggest that surgeons should be cautious of the possibility of renal rupture in blunt trauma due to the change of normal morphological structure of the kidney and attenuation of the renal parenchyma.

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management.

Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome. This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy. A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review. The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported. When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication. Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.

Recurrent hydronephrosis and spontaneous renal rupture caused by lymphoplasmacytic inflammation in a cat

A seven-year-old male cat that was previously diagnosed with – and treated for – left hydronephrosis due to suspected idiopathic proteinaceous materials in the renal pelvis, presented with a short history of anorexia and vomiting. The abdominal ultrasound revealed bilateral hydronephrosis, and the intravenous pyelography showed a moderate amount of free fluid in the retroperitoneal space at 48 hours. After the nephrectomy, the gross examination of the right kidney revealed a very thin capsule with urine leakage, and the right renal pelvis showed small, black deposits. The histopathology of the right kidney revealed hydronephrosis with compression atrophy, necrosis of the renal cortex/medulla, and a moderate lymphoplasmacytic inflammation. The crystallographic analysis revealed that the black deposits were composed of 100% protein and no minerals. The cat was diagnosed with hydronephrosis and spontaneous renal rupture caused by proteinaceous pelvic materials, secondary to the idiopathic renal lymphoplasmacytic inflammation. In addition to revealing the possibility that immune-mediated renal disease can induce spontaneous renal rupture in cats, this case report demonstrates the utility of imaging for diagnosing and monitoring hydronephrosis, detecting urine leakage, and planning surgery.

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Objective: To synthesise all available data to determine the best management for urolithiasis-related renal forniceal rupture (RFR), with particular reference to the National Institute for Health and Care Excellence (NICE) 2019 Renal and Ureteric Stone Guidelines. Methods: PubMed search to March 2020 using permutations of renal, forniceal, fornix, calyceal, calyx and rupture. Non-English abstracts, editorial comments, letters to the editor and abstracts of conference proceedings were excluded. Results: An initial PubMed search retrieved 126 titles which were screened for relevance and five further titles were added from associated references. 64 abstracts were subsequently assessed, with 25 articles proceeding to full paper review. Conclusions: In cases of RFR secondary to ureteric calculi, management options, including conservative management, for the stone should be considered without the decision being influenced by the presence of the rupture. Perirenal abscesses secondary to RFR are rare, occurring in less than 0.25% of cases. Evidence supports restricting antibiotic prophylaxis to patients with a history of recurrent urinary tract infections or a positive urine culture, in line with the European Association of Urology’s antibiotic stewardship general management principle. RFR is not inherently a contraindication to primary ureteroscopy, which has particularly relevance with the drive to meet the 2019 NICE recommendations. Level of evidence: Not applicable to this literature review.

Spontaneous renal fornix rupture in pregnancy and the post partum period: a systematic review of outcomes and management

BackgroundSpontaneous renal fornix rupture (SRFR) causing urinoma is an uncommon but serious condition in pregnancy. Limited information is available to describe the natural history and outcomes to guide appropriate treatment. The aim of this study was to determine the natural history and outcomes of SRFR to determine appropriate management recommendations.MethodsA systematic review of literature databases was performed, using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) checklist from 1950 – April 2020. Inclusion criteria included any urinary extravasation from the kidney or ureter during pregnancy, or in the 8 weeks following delivery, confirmed via imaging or surgery. Haematomas and non-confirmed cases were excluded.ResultsA total of 1579 records were originally identified, of which 39 case reports were appropriate for inclusion. SRFR was most commonly reported during the first pregnancy (72%), 19/30 during the third trimester and 9 in the post-natal period. All patients presented with pain, with haematuria positive on urine dipstick in only 36% of 26 reported cases. Ultrasound was the most frequently used imaging modality, resulting in a diagnosis in 42% of cases. All cases reported on treatment procedures including ureteric stents (46%), percutaneous drain (15%), conservative management (15%), nephrostomy (13%) and ureteral catherization (10%). Long term urological outcomes were positive, however women suffering SRFR were significantly more likely to undergo pre-term labour.ConclusionWhile selected cases may be successfully managed conservatively, urinary diversion, through ureteric stents, should be considered the management of choice in these individuals. Clinicians should be mindful of an increased risk of premature delivery and its’ associated negative fetal outcomes.

Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report

BackgroundAtraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction.Case presentationA 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted.ConclusionsSpontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.

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

BackgroundSpontaneous 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 presentationA 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.ConclusionClose 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.

Diagnosis and treatment of spontaneous rupture of renal pelvis caused by pelviureteric junction obstruction in infants

Objective To analyze the clinical features of spontaneous rupture of the renal pelvis (SRRP) in infants caused by UPJO. Methods A retrospective analysis of 7 cases of SRRP in infants caused by UPJO in our hospital from October 2013 to October 2018 was performed. All the patients included 5 males and 2 females. The average age was(12.0±6.1) months(ranging 2 days-25 months). 3 cases suffered renal rupture in left side and 4 cases suffered renal rupture in right side. 2 cases had grade Ⅲ hydronephrosis and 5 cases had grade Ⅳ hydronephrosis. Other symptoms included fever in 4 cases, digestive symptoms in 3 cases, oliguria in 2. 7 cases were revealed RBC(+ + + )with urinary occult blood positive in urine test. 6 cases were found the white blood cells in urine was more than 8/μl. 3 cases had the elevated blood C-reactive protein.3 cases suffered with renal function insufficiency, which the creatinine was more than 110 μmol/L. The 2 cases of urinary extravasation was found in the posterior abdominal cavity and 2 in posterior abdominal cavity and abdominal cavity by CT enhanced scan. 4 cases performed open pyeloplasty, nephrostomy and perirenal drainage.2 cases performed pyeloplasty, nephrostomy, abdominal and perirenal drainage. 1 case performed perirenal drainage and retrograde indwelling Double-J stents. Results All operation performed successfully. The median operation time was 84 min (ranging 45-90 min). The estimate blood loss was 15 ml (ranging 10-35 ml)without any transfusion. The median time of postoperative perirenal drainage tube was 3 d (ranging 2-5 d), The median time of the abdominal drainage tube was 5 d (ranging 3-7 d), the median time of nephrostomy was 12 d (ranging 10-14 d). The median hospital stay was 14 d (ranging 10-21 d). The median follow-up was 18 months (ranging 3-36 months). One performed the second stage pyeloplasty after double-J stents removed, and the renal function gradually recovered. Conclusions The SRRP in infants caused by UPJO is rare and easily misdiagnosed. The degree of hydronephrosis and inflammation may be important factors affecting the spontaneous rupture of pediatric renal pelvis. When it occurs, it requires active intervention by the operation, while treating the stenosis of the UPJ and draining the extravasation of urine. Key words: Hydronephrosis; Spontaneous rupture of the renal pelvis; Ureteropelvic junction obstruction

A rare cause of abdominal pain: Renal calix rupture

A rare cause of abdominal pain: Renal calix rupture

SPONTANEOUS RENAL RUPTURE TREATED BY TRANSCATHETER ARTERIAL EMBOLIZATION: A CASE REPORT

We describe our experience with a case of spontaneous renal rupture. A 43-year-old man visited our hospital with a chief complaint of left back pain with no identifiable triggering factors. A CT scan showed a rupture involving the left renal parenchyma and hematoma around the kidney. However, there were no apparent causes of the renal rupture, such as tumors and vascular lesions. Based on these findings, he was diagnosed with spontaneous renal rupture. Due to progression of anemia during the course, he underwent transcatheter arterial embolization of the kidney. He continues to undergo imaging examinations on a regular basis and has shown no development of apparent neoplastic lesions for 13 months.

Unilateral nephrolithiasis with renal rupture in a horse

SummaryA 22‐year‐old Thoroughbred mare presented to North Carolina State University Large Animal Hospital for evaluation of acute colic. After initial work‐up, the mare was diagnosed and treated for presumed gas colic. She was subsequently further diagnosed and treated for gastric ulcers and mild sand accumulation in her large colon, based on gastroscopy and abdominal radiographs, respectively. The mare initially responded well to medical management of colic, but on Day 3 of hospitalisation, developed a low grade fever and signs of mild discomfort returned. Abdominocentesis at that time revealed an aseptic peritonitis and she was placed on antibiotics andNSAIDs. When no significant improvement was achieved, the mare was taken to surgery 2 days later. In surgery, she was diagnosed with nephrolithiasis of the left kidney that had erupted through the renal capsule and into the retroperitoneal space, as well as into the abdomen. Two nephroliths were found in the omentum. The mare was subjected to euthanasia due to a poor prognosis and submitted for necropsy, where 54 nephroliths were identified, associated with the left kidney. This report describes significant unilateral nephrolithiasis (to the point of renal rupture) in a horse with no azotaemia or other clinical signs of urinary tract disease.

Conservative management for acute renal rupture in blunt trauma

Renal injuries are commonly reported in blunt abdominal trauma and are usually associated to other abdominal injuries. Renal rupture may be misdiagnosed and its management, especially in severe lesions, is still controversial. We describe the case of renal rupture diagnosed in the Emergency Department and conservatively managed. The outcome was good thanks to the early diagnosis and the management of the renal trauma. Conservative management in renal rupture is possible in stable patients provided that the imaging is early done.

Case Report on Ruptured Renal Artery Aneurysm

Renal aneurysms are a rare entity with an incidence of 0.09% of the population. They are often asymptomatic and frequently discovered incidentally during abdominal imaging for unrelated causes. Rupture of renal artery aneurysms is a surgical emergency, very often lethal. Swift diagnosis is crucial and is made by ultrasound and abdominal MDCT. We report the case of a renal artery rupture in a 58 year-old man who arrived in the emergency department with left flank pain of sudden onset followed by a hypovolemic shock. MDCT scan showed the rupture of an aneurysm of the left renal artery associated with a retroperitoneal hematoma. It is a life-threatening situation in case of delayed diagnosis. In our case, prompt imaging and diagnosis led to conservative treatment and nephrectomy was avoided.

Spontaneous Renal Artery Pseudoaneurysm Rupture with No Precipitating Risk Factor Presenting as Acute Abdomen

Spontaneous Renal Artery Pseudoaneurysm Rupture with No Precipitating Risk Factor Presenting as Acute Abdomen

Ruptured Renal Pelvis Due to Obstruction by Ureterosciatic Hernia: A Rare Condition With a Rare Complication

Ureterosciatic hernia is an extremely rare condition. Here we report a case of ureterosciatic hernia presented with sudden loin pain, with contrast computed tomography and antegrade pyelogram demonstrating ureterosciatic hernia causing ureteric obstruction and renal pelvic rupture. Subsequently, laparotomy with hernia reduction and mesh repair was performed.