Renal Rupture Research Articles

Spontaneous Renal Rupture During Pregnancy

Spontaneous rupture of the renal parenchyma or renal pelvis during pregnancy has been previously reported in 16 cases. In the case we describe in this report, the patient initially had right flank pain and nausea for 48 hours, which progressed to severe abdominal symptoms that necessitated exploratory laparotomy. Cystoscopic placement of a ureteral stent relieved the obstruction and allowed spontaneous healing of the renal pelvis. Dilatation of the urinary collecting system commonly occurs during pregnancy. Spontaneous rupture of the renal parenchyma or renal pelvis, however, is unusual and often associated with diseased kidneys. Our case is the 8th one of spontaneous rupture of the renal collecting system with no identifiable underlying pathologic condition and the 17th case of spontaneous renal rupture overall.

Chronic Renal Failure for Bilateral Spontaneous Kidney Rupture in a Case of Tuberous Sclerosis

A case of spontaneous, but not contemporary rupture of both kidneys in a 42-year-old man with tuberous sclerosis is described. Despite the high incidence of renal involvement, chronic renal failure due to replacement and compression of renal tissue by hamartomas is rare. We reviewed 25 cases in the literature and found only 1 other case which necessitated maintenance hemodialytic treatment for kidney rupture. It is suggested that early diagnosis and conservative partial nephrectomy could prevent or delay the onset of chronic renal failure, malignant transformation and dramatic rupture of hamartomas.

Renal arterial rupture complicating transluminal angioplasty.

Renal arterial rupture complicating transluminal angioplasty.

Rupture of the Renal Artery After Percutaneous Transluminal Angioplasty

To the Editor.— Olin and Wholey 1 described the pathology of renal artery injury after angioplasty, but did not emphasize prevention of morbidity and mortality in the broader clinical application of this technique. At another academic institution, I observed three deaths directly related to renal artery angioplasty, two from aortic thrombosis and one from renal artery rupture. Several lessons stand out: These complications occurred with skilled angiographers, but without prior surgical consultation and at a time inconvenient for the availability of an operating room. A qualified surgeon should be available to assess these patients for major complications such as aortic thrombosis, arterial dissection, or retroperitoneal hemorrhage. Angioplasty should never be performed simply because an anatomic lesion has been discovered. If the proper diagnostic studies have not been done and absolute indications for angioplasty do not exist, the procedure should be deferred. Repeated arterial catheterization for a secondary procedure under controlled

Clinical Indications for Radiographic Evaluation of Blunt Renal Trauma

The evaluation of patients with blunt renal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microhematuria without shock and with renal contusion, we reviewed the medical records of 831 patients with hematuria following blunt renal trauma. Microscopic hematuria without shock was noted in 160 of 241 patients without and 334 of 590 with associated injuries. Of the former 160 patients 159 had renal contusion and 1 had a renal laceration, while of the latter 334 patients 329 had renal contusion, 3 had renal laceration, 1 had renal rupture and 1 had a pedicle injury. Most patients with microscopic hematuria and no shock after blunt renal trauma had a renal contusion, especially those with no associated injury. All of the patients with renal contusions experienced no complications from nonoperative management. However, avoiding a radiographic evaluation in patients with blunt renal trauma plus microhematuria and no shock would miss a few cases of severe renal injury.

Management of perirenal hematoma found during laparotomy in patient with multiple injuries

The medical records of 158 patients with perirenal hematoma found during laparotomy for intra-abdominal injury from external trauma were analyzed. Small perirenal hematomas were usually associated with renal contusions and renal artery thrombosis, while large perirenal hematomas often were present with large renal lacerations, renal ruptures, and renal pedicle injuries with rupture of the renal vein, renal artery, polar artery, or branch of the renal artery. The management of the perirenal hematoma found during laparotomy depends on the degree of the underlying renal injury and not on the size or extent of the perirenal hematoma.

Spontaneous rupture of a hydronephrotic kidney during pregnancy

Acute abdominal pain during pregnancy can be of urologic origin. Hydronephrosis of pregnancy can be complicated by symptomatic renal colic, pyelonephritis, and secondary renal abscess formation. In this report, rupture of a hydronephrotic kidney with retroperitoneal urinoma formation was treated by retroperitoneal drainage and internal ureteral diversion until a term delivery was achieved. However, if severe renal hemorrhage accompanies renal rupture, surgical exploration of the kidney with partial or complete nephrectomy may be necessary.

Conservative or immediate surgical management of Blunt renal injuries

From 1969 to 1981, 1,176 blunt renal injuries were recorded in 1,166 patients (10 patients had bilateral injuries). Conservative management of 27 patients with severe renal injuries resulted in a delayed renal operation in 30 per cent and total renal loss in 22 per cent. A review of the published series of the conservative management of patients with severe renal injuries (laceration, rupture and pedide injury) shows a renal surgery rate of 13 to 68 per cent, a renal loss rate of 3 to 33 per cent and a significant complication/renal surgery rate of 13 to 76 per cent. In our patients 88 per cent with severe renal injuries had associated injuries and 73 per cent of these underwent immediate laparotomy for intra-abdominal injury. Immediate renal surgery in 59 patients with severe renal injuries resulted in a nephrectomy rate of 6.5 per cent of 31 renal lacerations, 100 per cent of 14 renal ruptures and 50 per cent of 14 pedide injuries. Of the 14 patients with pedicle injuries 6 (43 per cent) had immediate vascular repair, with salvage of the kidney. Immediate surgical management of the patients with severe renal injuries obviated the need for a second exploration in a severely injured patient, reduced morbidity and resulted in increased renal salvage.

Blunt renal trauma in children.

From 1969 to 1981 blunt renal injuries were recorded in 219 children up to the age of 16 years. All children with renal laceration, rupture, or pedicle injury had associated injuries, and 76% of them had a laparotomy for intra-abdominal injury. Conservative management of five severe renal injuries in children resulted in 40% having a delayed renal operation and a total renal loss in 40%. A review of the published series of conservative management of severe renal injuries in children shows a renal surgery rate of 17 to 70%, a renal loss rate of 5 to 40%, and a significant complication/renal surgery rate of 32 to 80%. If conservative management of severe renal injuries in the multiple-injured child is used then up to 70% will require a second operation for the renal injury in a critically ill child recovering from the first operation. The nephrectomy rate with immediate surgical management of 16 severe renal injuries was 11% with nine renal lacerations, 100% with four renal ruptures, and 33% with three pedicle injuries. Two (67%) of the three pedicle injuries had immediate vascular repair with salvage of the kidney. There was increased renal salvage, reduced morbidity, and no need for a second exploration with immediate surgical management of severe renal injuries.

Sonographic manifestations of acute renal vein thrombosis: an experimental study.

Complete unilateral ligation of the renal vein was done in five adult mongrel dogs. An initial ultrasound examination was performed at 6 hours with serial scans every 12 hours until the animals died or were sacrificed. There were a number of sonographic findings, consisting of immediate renal enlargement, increased cortical thickness, sparsely distributed cortical echoes with increased transonance, indistinct cortico-medullary boundary, parenchymal anechoic areas due to hemorrhage and hemorrhagic infarct, compressed renal parenchyma appearing as echogenic clusters, dilated renal veins, and renal rupture. These findings corresponded to changes in the pathologic specimens and were dependent upon the duration of the venous occlusion. In patients clinically suspected to have renal vein thrombosis, the combination of the above-described sonographic findings supplemented with findings on excretory urography should be sufficient for the diagnosis of renal vein thrombosis, eliminating the need for invasive procedures.

Spontaneous renal rupture in pregnancy

A review of the literature reveals 9 cases of spontaneous renal rupture in pregnancy, to which we add another case. Most cases occurred in hydronephrotic kidneys. Four cases consisted of renal rupture without associated infection or tumor, 3 were associated with abscesses, and 3 ruptured through renal hamartomas. Previously, all ruptured kidneys were removed. In our case the kidney was salvaged satisfactorily by prompt placement of a nephrostomy tube and drainage of the perirenal tissue. Attempt at renal salvage is urged for renal rupture in pregnancy.

The Role of Ultrasound in the Diagnosis of Kidney Allograft Rejection

Seventeen nephrectomized dogs underwent kidney transplantation from unrelated donors. Routine immunosuppressive therapy was administered. Serial ultrasound studies and biopsies and complete pathological examinations were performed and compared. A number of sonographic changes were observed within the renal parenchyma during rejection, some of which were present before a significant rise in serum creatinine levels. The medulla became enlarged due to edema, followed by growth of the rest of the kidney and thickening of the cortex. The cortical echoes became more sparsely distributed and either increased or decreased in amplitude; distribution was generalized or localized. During rejection, the corticomedullary boundary became indistinct. Later, a decrease in the renal sinus echoes was also noted. In 2 cases, perirenal fluid collections occurred as the result of renal rupture.

Renal rupture after transplantation

Nine instances of spontaneous allograft rupture have been identified in a series of 325 renal transplantations. Repair of the graft was accomplished in 4 cases. One graft functioned for five and one-half years, one kidney was removed immediately because of uncontrolled hemorrhage, and two grafts were subsequently removed because of rejection. Immediate nephrectomy was performed in 5 cases of irreversible rejection. The duration of ischemia and method of preservation appeared to have no etiologic importance. Evidence of severe acute rejection was present in all 9 cases. The recent increase in graft rupture parallels the increasing frequency of severe early acute rejection reactions.

Spontaneous rupture of kidney Associated with renal papillary necrosis

Two cases are presented in which rupture of the kidney was associated with ureteral obstruction from a sloughed papilla secondary to papillary necrosis. In one case papillary necrosis was associated with phenacetin ingestion and a relatively benign course. In the other instance there was a fulminating course in which papillary necrosis was associated with diabetes mellitus. Ureteral obstruction from papillary necrosis requires prompt intervention, the delay of which may lead to renal rupture and extravasation of blood and urine with its inevitable consequences.

MULTIPLE INTRAPARENCHYMAL RENAL ANEURYSMS IN POLYARTERITIS NODOSA.

Polyarteritis nodosa is a widespread disease, characterized by a focal necrotizing inflammation of the vessel walls. It primarily affects arteries of medium and small size. Renal involvement is reported in roughly 80 per cent of the cases (1), and the kidney is the most frequent organ affected. It is the purpose of this paper to document for the first time the in vivo demonstration of multiple intraparenchymal renal aneurysms occurring in this disease. Pathology The microscopic pathological changes of polyarteritis nodosa can be divided into stages, one or all of which can be observed at necropsy (9). Initially, mucoid degeneration and acute fibrinoid necrosis begin in the media, subsequently extending into the other layers. Infiltration of neutrophils and later by eosinophils then occurs, associated with destruction of the elastic lamina and subsequent aneurysm formation. The acute cellular infiltration subsides with the appearance of chronic inflammatory cells, but the prominent part of the next phase is marked proliferation of connective tissue which replaces areas of destroyed intima and media. This can lead to the characteristic nodularity. If thrombosis hasn't already occurred it does so at this time, leaving a vessel that now resembles a fibrous cord. Any of the vessels of the kidney may be involved, but the arcuate and interlobular arteries and arterioles are affected the most frequently. Thus, multiple small infarcts of the kidney are a prominent feature. The scarring which results is responsible for the irregular renal contour so frequently noted on gross examination. The glomeruli are also abnormal in most patients. The healed glomerulitis and vasculitis seem to be prominent features associated with the production of hypertension in polyarteritis nodosa (10). Aneurysm formation in the parenchymal vessels, although virtually pathognomonic of polyarteritis, is a rather uncommon pathologic finding. Ralston and Kvale (7) in reviewing 30 cases from the Mayo Clinic did not find a single instance of renal artery or arteriolar aneurysm. Davson (1), however, discovered at autopsy 4 cases of intrarenal aneurysms, in a series of 14 of polyarteritis. A review of the renal pathology in 32 autopsied cases of polyarteritis at the Columbia-Presbyterian Medical Center disclosed that in only 1 were gross or microscopic intrarenal artery aneurysms found. Death in this instance was precipitated by rupture of one of the aneurysms, renal rupture, and retroperitoneal hemorrhage. This complication of polyarteritis is well recognized, and over 30 cases describing this morbid sequence of events have appeared in the literature (4, 6, 11). Patients in this group are invariably males in the third or fourth decade, often hypertensive, who present with flank pain and a palpable mass. Most will die of retroperitoneal hemorrhage, with polyarteritis diagnosed at autopsy.