Renal Rupture Research Articles

Spontaneous Renal Calyceal Rupture: A Rare Cause of an Acute Abdomen in Pregnancy

Spontaneous Renal Calyceal Rupture: A Rare Cause of an Acute Abdomen in Pregnancy

Spontaneous rupture of the kidney in the patients with synchronous renal hemangioma and nephrogenic hypertension.

Most renal neoplasms in adults are epithelial in origin and mesenchymal tumors are rarely encountered. Vascular tumors and tumor-like lesions account for a very small subset. Hemangioma of the kidney is a rarely seen benign vascular neoplasm that probably arises from angioblastic cells. Its general sign is macroscopic hematuria with or without pain. Preoperative diagnosis is difficult or impossible. Previously, spontaneous rupture of the kidney caused by renal hemangioma was not reported in the English literature. In this study, two cases with a history of nephrogenic hypertension who presented with spontaneous renal rupture are presented. There wasn't any trauma history in the background of our patients. A long-standing nephrogenic hypertension was present in both patients. Patients underwent radical nephrectomy due to rupture of the renal tumor. In histopathological examination, capillary hemangioma was detected in the renal medulla in both cases. Patients didn't need antihypertensive therapy during the postoperative period.

Spontaneous renal allograft rupture due to iliac vein thrombophlebitis

Renal allograft rupture is one of the most dreaded complications in patients of kidney transplantation. It has a dramatic and stormy course and may be life threatening for the patient. Although rare, it has to be recognised early and surgical correction and or graft nephrectomy may often be required to salvage the patient. It is usually observed in the first two weeks after transplant. We herein report a case of spontaneous renal allograft rupture in a 50 years old female patient who had undergone a live donor kidney transplantation from her spouse. The patient had a renal rupture on ninth day of surgery. She was re-explored and the rupture was repaired using 2-0 vicryl mattress sutures over surgicell. Her graft recovered completely by day 3 after the repair. However she had pulmonary embolism a day prior to discharge and she succumbed with a functioning graft.

RENAL FLAGELLATE INFECTIONS IN REPTILES: 29 CASES

Renal infection with flagellated protozoa was retrospectively evaluated in 29 reptiles, including 12 turtles, 7 tortoises, and 6 chameleons; overall, 20 species of reptiles were represented. Most cases presented with nonspecific clinical signs or a combination of several concurrent diseases. Nineteen of 29 reptiles had tubulointerstitial nephritis associated with flagellates, and this lesion was considered contributory to death in 15 cases, although concurrent diseases were frequent. Infection was invasive into the renal interstitium in three reptiles due to tubular rupture and in one chameleon also spread to adjacent tissues, coelomic cavity, and blood vessels due to renal rupture. Cytologic or ultrastructural evaluation of trophozoites in two cases was consistent with diplomonad flagellates. Renal disease was often complicated with soft-tissue mineralization and/or gout. Gastrointestinal and cloacal infection with flagellates and inflammation were frequent in reptiles in which the digestive tract was available for histopathologic examination, and this supports the possibility of infections ascending the urinary tract from the cloaca. Renal disease associated with flagellate protozoa is rare in vertebrates but appears to be relevant in reptiles, particularly chelonians and chameleons.

Spontaneous Renal Rupture Following Urinary Tract Infection and Its Recovery through Conservative Treatment

60세 여자가 내원 당일 갑자기 발생한 우측 측복통을 주소로 응급실에 내원하였다. 통증은 지속적이나 우측 옆구리에 국한되 어 있었고 움직일 시 악화되는 양상이었다. 동반된 발열, 오심, 구 토, 혈뇨 증상은 없었다. 환자는 약 10년 전 진단받은 고혈압으 로 경구 혈압 강하제를 복용 중이고 혈압약 이외에 항혈전제를 포함한 다른 경구 약이나 한약 등의 복용력 없었다. 당뇨, 간염 및 결핵 등의 특이 병력 없었으며 흡연력 없이 약 10년간 막걸리 1~2병을 2~3일마다 섭취한 만성적 음주력이 있었다. 신체검사에 서 혈압은 109/67 mmHg, 맥박 분당 70회, 호흡수는 분당 20회, Case Report Ewha Med J 2014;37(Suppl):S1-S4 http://dx.doi.org/10.12771/emj.2014.37.S.S1 pISSN 2234-3180 • eISSN 2234-2591

Urétéro-hydronéphrose avec rupture du fornix sur masse ovarienne suspecte

Extravasation of urine following rupture of the renal fornix is a rare complication mostly caused by obstruction secondary to distal ureteric stones. This 35-year-old woman was referred with back pain. Her CT scan revealed rupture of the renal fornix secondary to a pelvic mass. Laparoscopy subsequently confirmed this to be an ovarian abscess. We report the first case of spontaneous renal forniceal rupture secondary to pelvic inflammatory disease.

Renal rupture with perirenal hematoma after ureterorenoscopic holmium:YAG laser lithotripsy for a renal pelvic stone

We present a rare, but critical case of renal rupture after ureterorenoscopic holmium:YAG laser lithotripsy. This is the first case report of renal rupture after laser lithotripsy in managing an upper urinary tract stone. A 75-year-old male underwent retrograde ureterorenoscopic holmium:YAG laser lithotripsy for a left renal pelvic stone. A drop in blood pressure was noted postoperatively. Abdominal computed tomography confirmed a left subcapsular, perirenal hematoma and a stone which had dropped out to the left subcapsular space.

Renal Papillary Necrosis with Calyceal Rupture: Caused by Acute Pyelonephritis and Analgesic Abuse

Spontaneous renal rupture is a rare condition. Renal rupture most often occurs as a result of traumatic injury, a rare entity of obstructive uropathy with stones, and spontaneous causes such as malignancy. We report on a rare case of renal rupture caused by a ureter stone measuring 5 mm in size with acute pyelonephritis (APN) in a patient with renal papillary necrosis (RPN). The patient, who suffers from attacks of gouty arthritis, frequently used analgesic for pain relief. The patient was treated with temporary percutaneous drainage and antibiotics. This case demonstrates that RPN with APN can induce renal rupture even when ureter stones are small. Thus, consideration of all medical problems is important when deciding on treatment of patients with ureter stones.

Spontaneous Renal Pelvis Rupture: Unexpected Complication of Urolithiasis Expected to Passage with Observation Therapy

Seventy percent of ureteral stones are located at distal ureter. Effective and safe passage of distal ureter stones is mediated by observation or medical expulsive treatment. Most of stones located at distal ureter pass spontaneously under observation; however, some are complicated with urinary tract infection, hydronephrosis, and renal function disturbances. Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. This case is reported, because the patient developed an unexpected spontaneous renal pelvis rupture (SRPR), while she was under observation and expected to pass her right ureteral stone spontaneously through hydration and analgesic treatment.

Transarterial embolization for serious renal hemorrhage following renal biopsy

The goal of this study is to evaluate the feasibility and efficacy of percutaneous transarterial embolization for the treatment of serious renal hemorrhage after renal biopsy. Nine patients with renal hemorrhage had frank pain and gross hematuria as main symptoms after renal biopsy. Intrarenal arterial injuries and perinephric hematoma were confirmed by angiography in all cases. The arterial injuries led to two types of renal hemorrhage, Type I: severe renal injure or intrarenal renal artery rupture (n=5), with contrast medium spilling out of the artery and spreading into renal pelvis or kidney capsule in angiography; Type II, pseudo aneurysm or potential risk of intrarenal artery injure (n=4), where contrast medium that spilled out of intraartery was retained in the parenchyma as little spots less than 5 mm in diameter in angiography. Transcatheter superselective intrarenal artery embolization was performed with coils or microcoils (Type I intrarenal artery injure) and polyvinyl alcohol particles (Type II injure). The intrarenal arterial injuries were occluded successfully in all patients. Light or mild back or abdominal pain in the side of the embolized kidney was found in three patients following embolization procedures and disappeared 3 days later. Serum creatinine and perinephric hematoma were stable, and gross hematuresis stopped immediately (n=4) or 3-5 days (n=3) after embolization. In conclusions, transcatheter superselective intrarenal artery embolization as a minimally invasive therapy is safe and effective for treatment of serious renal hemorrhage following percutaneous renal biopsy.

Delayed Repair of a Traumatic Lumbar Hernia with Renal Rupture

Delayed Repair of a Traumatic Lumbar Hernia with Renal Rupture

Xanthogranulomatous Pyelonephritis Presented with Spontaneous Kidney Rupture in a Young Woman

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and aggressive form of inflammation of the renal parenchyma particularly resulting in diffuse renal destruction. A previously healthy 25-year-old woman was admitted to our clinic with right flank pain of sudden onset, nausea and high fever. Computed tomography revealed a mass (12 x 7 cm in diameter) around the right kidney with extension to pelvis and paravertebral space. Flank incision was made urgently and a very large perirenal haematoma and abscess formation were found caused by the rupture located at the posterior side of the right kidney. A right nephrectomy was performed and abscess material was evacuated from the perirenal area. XGP was diagnosed by histopathologic examination of the resected kidney. Although XGP regularly demonstrates a gradual progression and presents with nonspecific symptoms, the situation may appear with complications as in our case. Our patient presented with renal rupture and perirenal abscess extending to the pelvis and paravertebral space. To the best of our knowledge, this is the first report of XGP presenting with spontaneous renal rupture in the English literature.

An Unusual Case of Abdominal Pain

Renal calyceal rupture is a usual etiology of abdominal pain in the emergency department. We present a case of unexpected renal calyx rupture in a patient with symptomatology of renal colic. A discussion and review are provided.

Renal artery rupture during complicated recovery from angioplasty to treat renal stenosis.

Renal artery rupture during complicated recovery from angioplasty to treat renal stenosis.

Bilateral Spontaneous Perirenal Hemorrhage in an Acquired Cystic Kidney Disease Hemodialysis Patient

Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics.

Perirenal Hematoma Secondary to Renal Rupture with Concurrent Splenic Rupture in a Twelve-Week-Old Boerbeol Puppy: A Case Report

The dog kidneys are elongated and are located retroperitonealy between the thirteen thoracic vertebrae and the third lumber vertebrae. The right kidney is usually more cranial than the left (Feeney and Johnston, 2007). Each kidney consists of an outer cortex and an inner medulla which projects into the pelvis. The kidney receives approximately twenty percent of the cardiac output through the renal arteries. Renal injury is observed in about ten percent of cases of abdominal injury in humans (Razali et al., 2010). However, the exact incidence of renal injury in dogs is unknown. Majority of renal injuries are attributable to blunt trauma, while the rest are due to penetrating injuries, commonly gunshot wound and stab wounds (Kawashima et al., 2001; McAninch and Santucci, 2002). Renal injuries from blunt trauma usually occur as a consequence of a direct blow to the flank or from rapid deceleration (Razali et al., 2010). A direct blow will crush the kidney, causing a laceration or lacerations of the renal parenchyma and resulting in a subcapsular, intrarenal or perinephric hematoma (Dunnick et al., 2001). The development of perirenal haematoma is rare and primarily the result of trauma, malignancy, or a connective tissue disease (Pavel et al., 2008). Infrequently, persistent or mild trauma can cause severe perirenal haematoma resulting in abdominal pain, hematuria and shock. In humans, kidney injury is common with falls and automobile accidents; however there is dearth of information of the causes of kidney rupture in dogs. In veterinary patient, trauma and neoplasia have been recognized as the two most common causes of haemoperitoneum (Vinayak & Krahwinkel, 2004). Vehicular trauma has reportedly caused intraabdominal injury in 6.3 – 13 percent of injured animals (Brockman et al ., 2000). The liver, spleen, kidneys and major vessels are the commonly affected structures, while the liver and the spleen are the most likely sources of severe haemorrhage (Fossum, 1997). Blunt trauma to the spleen and liver can involve a delay of up to three hours or more before signs of shock will develop (Vinayak & Krahwinkel, 2004). This report presents a case of severe haemoperitoneum from splenic laceration and perirenal hematoma secondary to renal rupture in a twelve week old Boerboel puppy after reportedly falling from a height.

Acute renal artery aneurysm rupture – a rare differential diagnosis of acute appendicitis

A 50-year-old patient with symptoms of an acute appendicitis turns out to be suffering of a life threatening rupture of a renal artery aneurysm. We performed an emergency operation with the resection of this aneurysm. An imminent hemorrhagic shock made a targeted intensive medical therapy necessary.

Spontaneous Renal Pelvis Rupture Due To Ovarian Carcinoma: Case Report

Peripelvic extravasation related to spontaneous rupture of the renal pelvis is a rare occurrence, but is commonly associated with obstructing calculus. Spontaneous renal pelvis rupture and urinoma due to a tumor is very rare. In this case report, clinical presentation and radiological imaging findings of a case with development of renal pelvis rupture and peripelvic extravasation due to ovarian carcinoma is discussed.

Renal fornix rupture following diagnostic coronarography

A 31-year-old man with an uneventful medical history presented at the emergency department with complaints of exercise-related chest pain for 3 weeks. ECG showed ST-elevations in the inferior leads. A diagnostic coronarography was performed and showed multivessel coronary stenosis. During this procedure 200 ml of a nonionic, low-osmolality monomeric contrast agent (Iomeron 350®) and 1250 ml of isotonic saline solution was administered intravenously. After this procedure, the patient suffered from a sudden onset and progressive severe pain in the back and the right lumbar region. A plain CT of the abdomen performed 8 hours post coronarography showed contrast enhanced fluid in the renal sinus and the perinephric/peri-ureteral space (Fig. A (scout view), B (coronal) and C (sagittal) reformatted scans). There was a bladder overdistenstion with a CT-based volumetric estimation of 995 ml. No mechanical cause of upper urinary tract obstruction was present. Subsequent urological work-up included insertion of a bladder catheter (24 hours) and administration of peroral antibiotics. Ultrasound follow-up on the next day revealed no abnormalities and the patient was discharged.

Late Renal Allograft Rupture Associated with Cessation of Immunosuppression following Graft Failure

A 29-year-old man developed chronic allograft nephropathy 63 months after renal transplantation. He became symptomatic with advanced chronic graft failure; his immunosuppressive medications were reduced and he was commenced on haemodialysis. Two months following the withdrawal of immunosuppression, he presented with abdominal pain, haematuria, and a marked drop in haemoglobin. The patient was taken to the operating room, where the renal allograft was found to be ruptured, and graft nephrectomy was subsequently performed. Histological examination of the graft specimen showed severe haemorrhagic acute vascular cellular rejection in a background of marked chronic allograft vasculopathy. Immunostaining for C4d showed diffuse, strong, linear circumferential staining of the peritubular capillaries, indicating a concurrent antibody-mediated rejection. We report herein an unusual case of spontaneous renal allograft rupture that occurred long time after transplantation due to severe acute rejection following cessation of immunosuppressive medications for advanced chronic allograft failure. To the best of our knowledge, the time interval between transplantation and the rupture of this allograft is the longest of those reported in the literature.