Renal Subcapsular Hematoma Research Articles

Subcapsular renal hematoma in patients underwent upper ureteroscopic lithotripsy

Abstract Objective to demonstrate the risk factors of developing subcapsular renal hematoma ( SRH) in patients who underwent ureteroscopic lithotripsy for upper ureteric stones. Materials and Methods In a randomized controlled trial, 60 patients with an upper ureteric stone underwent URS lithotripsy either by laser or pneumatic. The inclusion criteria were age above 14 years old, of both sexes with an upper ureteric stone about 2 cm in diameter. Exclusion criteria were age below 14 years old, elevated serum creatinine level, patients with coagulopathies and pregnancy. The perioperative and postoperative outcomes were evaluated and postoperative pelvi-abdominal CT with intravenous contrast was done to detect if a subcapsular hematoma has been developed. Results There is no significant association between the formation of subcapsular renal hematoma and degree of hydronephrosis, chronic kidney disease (CKD), body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and preoperative bacteriuria as risk factors. Conclusions Subcapsular hematoma post-ureteroscopic lithotripsy (URSL) for impacted upper ureteric stones is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after ureteroscopic lithotripsy for obstructing proximal ureteral stones with thin renal cortices. Stone size, degree of hydronephrosis, operation duration, and perfusion pressure of hydraulic irrigation were associated with an increased risk of SRH formation. Management of post-URSL subcapsular hematomas needs to be customized for each patient.

Massive, Spontaneous Ruptured Renal Subcapsular Haematoma Following Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction

Background: Thrombolytic therapy remains widely used in majority of developing countries, where delivery of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately, complications following such therapy remains prominent, predominantly bleeding-related problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma following thrombolytic therapy. Case Report: A 61-year old gentleman presented following an episode of chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining PCI, the patient was counselled for thrombolysis using streptokinase which he had consented to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria, hypotension and altered mental status, associated with acute drops in haemoglobin levels. Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was performed revealing a massive renal subcapsular hematoma, likely secondary to previous thrombolysis. Discussion: Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our literature search revealed only one other similar case, although this was following administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic cerebrovascular accident. Conclusion: This case highlights the complexity in management, following the findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent selection.

1970 Spontaneous Page Kidney as a Cause of Gastric Variceal Bleed

INTRODUCTION: Gastric variceal bleeding occurs in 15–50% of patients with non-cirrhotic portal venous thrombosis but can also occur in cases of splenic vein thrombosis (SVT) due to the formation of isolated gastric varices (IGV). We present the first reported case of a page kidney causing splenic vein compression, thrombosis, and subsequent gastric variceal bleeding. CASE DESCRIPTION/METHODS: A 31-year-old stuntman presented with epigastric pain and worsening exertional dyspnea over 3 weeks. History was notable for melena and anemia with no reported ulcers on endoscopy. On admission, he had hemoglobin of 4.1 g/dl with severe iron deficiency and elevated reticulocyte count. There was no serologic evidence of hepatic or renal disease. A computed tomography (CT scan) of the abdomen revealed a large left-sided perirenal collection consistent with page kidney, splenomegaly and decreased caliber of the mid and distal splenic vein suggestive of nonocclusive SVT. His liver was normal. Initial endoscopy revealed an IGV type 1 and mild portal hypertensive gastropathy (Figure 1). CT angiography did not reveal a splenorenal shunt to pursue a balloon retrograde transvenous obliteration (BRTO). While admitted, he developed hematemesis and worsening anemia. Ultimately, underwent IR splenic vein stenting with a bare-metal stent and subsequent decompression of the gastric varices with brisk flow of the portal vasculature (Figure 2). DISCUSSION: Gastric varices are classified primarily by location with most involving the gastroesophageal junction due to portal hypertension. The incidence of bleeding is highest in IGV, typically associated with SVT. Common etiologies of SVT include pancreatitis, malignancy or trauma. Our case described an extrinsic splenic vein compression and subsequent thrombosis due to a sub-capsular renal hematoma possibly of unclear etiology. Treatment for GV often depends on local expertise, but commonly consists of cyanoacrylate injection, banding (especially in type 1 gastro-esophageal varices), transjugular intrahepatic portosystemic shunt (TIPS) placement, BRTO, and even splenectomy. More recently, in cases of IGV due to isolated SVT, splenic vein stenting has been increasingly utilized. In our case, TIPS would not address the pre-hepatic portal hypertension and cyanoacrylate was not available. Splenic vein stenting was thus chosen to decompress the IGV with excellent response seen on subsequent follow-up (Figure 1).

Clinical use of renal point-of-care ultrasound after extracorporeal shock wave lithotripsy

BackgroundExtracorporeal shock wave lithotripsy is widely used to treat symptomatic nephrolithiasis. Complications of this procedure can occur and point-of-care ultrasound can help to diagnose and manage some of these cases.Case presentationA 61-year-old man was admitted to the hospital with intense right lumbar pain 24 h after being submitted to a extracorporeal shock wave lithotripsy. Bedside ultrasound showed a hyperechoic subcapsular lesion along the right kidney. This finding, along with the clinical examination, suggested the diagnosis of subcapsular renal hematoma. The patient was managed conservatively with clinical and ultrasound reassessments.ConclusionsThis case shows the use of bedside ultrasound to diagnose a subcapsular renal hematoma as a complication of extracorporeal shock wave lithotripsy. However, the sensitivity is low and other image methods can be necessary to make the diagnosis.

Subcapsular renal hematoma after reterorenoscopy: a case report and literature review

目的 探讨输尿管镜术后肾包膜下血肿的临床诊治特点及预防措施。 方法 回顾性分析本院收治的1例输尿管镜术后肾包膜下血肿患者的临床资料，检索CNKI及Pubmed相关文献并进行复习讨论。 结果 1例24岁男性患者因左侧输尿管下段结石行输尿管镜下段狭窄扩张＋输尿管双J管置入术，术后第3天为了解结石残留情况复查泌尿系CT平扫发现左肾包膜下血肿，给予绝对卧床休息、止血、抗感染治疗，术后2个月复查肾包膜下血肿消失。 结论 输尿管镜术后并发肾包膜下血肿是临床上少见的严重并发症，应引起泌尿外科医生的重视，围手术期做好预防措施，及早发现，保守治疗为主，必要时可行血管介入或外科手术干预。

Subcapsular renal hematoma after ureteroscopy and transureteroscopic laser lithotripsy: A case report in a hospital of the western Amazon

Perirenal hematoma is a rare complication of transureteroscopic laser lithotripsy occurring in about 0.15% of cases. This rate is significantly lower than other forms of treatment, such as extracorporeal shock wave lithotripsy which presents an incidence of perirenal hematoma of up to 25%. This study reports the case of a 56-year-old woman who presented a left ureterolithiasis and a right renal cyst. She underwent a left transureteroscopic laser lithotripsy and complained of pain postoperatively although without hypotension or fever. Her abdominal CT scan showed a huge hematoma subcapsular around her left kidney without any signs of urinary leak. The patient was treated conservatively and exhibited favorable outcomes. Most renal subcapsular hematomas presents spontaneous resolution with conservative treatment, however, the puncture or surgical approach may be necessary when associated with sepsis, impaired renal function, hemodynamic instability, or urinary tract leakage evidenced on CT scans.

Severe pyonephrosis associated with spontaneous subcapsular renal hematoma

Non-traumatic spontaneous subcapsular renal hematoma, also known as Wunderlich syndrome, is a rare entity that is associated with some renal pathology, mainly tumors or cysts, anticoagulant drugs administration or unknown reasons. We present a case of an elderly patient that presented with spontaneous subcapsular renal hematoma and complete deterioration of his kidney due to severe pyonephrosis that was managed conservatively.

Spontaneous Renal Subcapsular Hematoma Due to Uncontrolled Hypertension Disease

Spontaneous Renal Subcapsular Hematoma Due to Uncontrolled Hypertension Disease

The spontaneous subcapsular renal hematoma after ureteroscopic lithotripsy: experience of diagnosis and treatment

目的 通过对输尿管镜术后自发肾包膜下血肿的回顾研究，了解这一少见并发症，提高临床水平。 方法 回顾性研究3例输尿管镜碎石术后自发肾包膜下出血的临床资料，复习相关文献，探讨其病因、发病机制和诊治。 结果 1例患者保守治疗好转，1例患者行B超引导下穿刺引流术，1例患者反复感染后行肾切除术。 结论 自发性肾包膜下血肿是输尿管镜少见的并发症，一旦发生危害极大。对术后血色素明显下降的患者应考虑并行影像学检查确诊，及时有效的抗感染和穿刺引流治疗对改善患者的愈后极其重要。

Hospital Readmissions Due to Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy

Hospital Readmissions Due to Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy

Page Kidney Following a Nonepisode Protocol Renal Allograft Biopsy: A Case Report

Page kidney refers to a clinical condition that is characterized by the acute onset of hypertension and renal dysfunction owing to external compression of the kidney by a hematoma, tumor, lymphocele, or urinoma. We report a case in which Page kidney occurred after a nonepisode protocol renal allograft biopsy. A 31-year-old man with end-stage renal disease received a living related kidney transplant from his father. One year later, a nonepisode protocol renal allograft biopsy was performed. A day later, the patient's serum creatinine level increased to 4.23 mg/dL, and a subcapsular renal hematoma was detected using ultrasonography and computed tomography. Page kidney was diagnosed, and immediate surgical removal of the hematoma was performed. Nine days after the operation, the patient's serum creatinine level had improved to 1.89 mg/dL. Page kidney is a serious but treatable complication of renal allograft biopsies, and clinicians should pay attention to such complications, even in the setting of nonepisode protocol renal allograft biopsies.

Subcapsular renal hematoma after retrograde ureterorenoscopic lithotripsy: our experience.

Ureterorenoscopy is the current standard treatment for ureteral and kidney stones, also stones greater than 2 cm can be removed. Complications linked to infectious processes or ureteral damage are the most frequently reported. Subcapsular renal hematoma is an extremely rare complication following this procedure. We report the retrospective experience of two urological referral units for stones disease by analyzing incidence, risk factors and management of subcapsular renal hematoma. Between May 2011 and December 2017, 2497 consecutive ureteroscopies for urolithiasis were performed by 8 skilled endourologists. A subcapsular renal hematoma was diagnosed in four cases (0.12%). Symptoms appeared few hours after intervention in two patients and after 14 postoperative days in the remaining two. In all cases CT scan revealed a subcapsular renal hematoma without signs of active bleeding. Conservative treatment was successful. Two patients required blood transfusion. One patient developed renal hypotrophy. Subcapsular renal hematoma represents a rare but potentially serious complication after ureterorenoscopic lithotripsy. Its real incidence and etiology still need to be clarified. The elevated intrarenal pressures play an important role. Persistent hematuria, flank pain and hemoglobin drop should guide prompt investigation to reach an early diagnosis. In most cases a conservative management is sufficient.

PP-5 - Renal Subcapsular Hematoma Caused by Hydrophilic Guide Wire During Patent Ductus Arteriosus Closure

PP-5 - Renal Subcapsular Hematoma Caused by Hydrophilic Guide Wire During Patent Ductus Arteriosus Closure

25 Page Kidney and Decreased Renal Function Secondary to Renal Subcapsular Hematoma After Extracorporeal Shock Wave Lithotripsy (ESWL)

25 Page Kidney and Decreased Renal Function Secondary to Renal Subcapsular Hematoma After Extracorporeal Shock Wave Lithotripsy (ESWL)

Recurrent infectious subcapsular renal hematoma accompanied by microaneurysm.

An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10days earlier, her oral intake gradually decreased with no other specific symptoms, such as abdominal pain, nausea, vomiting, headache, or low back pain. Abdominal computed tomography (CT) scan revealed a left subcapsular renal hematoma. We suspected infective subcapsular renal hematoma, so percutaneous needle aspiration and drainage were performed. Intravenous sulbactam-ampicillin was started immediately. On day 9 after admission, repeat CT scan revealed the subcapsular hematoma had reduced in size. The drain was removed, and intravenous antibiotics were discontinued. Follow-up CT scan on day 21 revealed increased subcapsular renal hematoma size. The patient also had high fever. Suspecting recurrence of infective subcapsular renal hematoma, we repeated the drainage of the hematoma and restarted intravenous antibiotics. Renal arteriography showed a renal artery microaneurysm and her condition improved with renal artery embolization. Renal arteriography was useful for detecting renal artery microaneurysm in infective subcapsular renal hematoma that did not resolve after antibiotic treatment and drainage.

Spontaneous Subcapsular Renal Haematoma in Adolescents: Report of Two Cases

Spontaneous Subcapsular Renal Haematoma in Adolescents: Report of Two Cases

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Spontaneous Subcapsular Renal Hematoma as a Complication of Acute Pyelonephritis: A Case Report

Abstract Spontaneous subcapsular renal hematoma (SSRH) emerged as a complication of acute pyelonephritis (APN) is an extremely rare condition. We showed a patient aged 63 years hospitalized due to languor, febrility, abdominal pain accompanied by nausea and vomiting. Ultrasound (US) examination of the abdomen and multidetector computed tomography (MDCT) showed the presence of subcapsular hematoma of the left kidney with calculus in the initial part of the left ureter. Laboratory tests registered a positive inflammation syndrome, anemia and an increase in nitrogen compounds. Based on laboratory results, clinical presentation and imaging techniques it has been found that it is APN with spontaneous subcapsular hematoma. After application of non-surgical treatment which included antibiotic therapy with percutaneous drainage of hematoma, a good clinical response with regression of subjective symptoms and hematoma was obtained. On repeated US and MDCT after 18 months no pathological changes in the kidneys were registered. Spontaneous subcapsular hematoma extremely rare occurs as a result of APN associated with calculosis. The use of non-surgical treatment, which includes appropriate antibiotic therapy with percutaneous drainage of hematoma would represent a method of first choice.

Diffuse Renal Cortical Hemorrhage in the Setting of Subcapsular Hematoma: Diagnosis and Treatment with Embolization

PurposeTo describe radiologic findings, embolization technique, and clinical outcomes in patients with renal subcapsular hematoma and diffuse cortical hemorrhage. Materials and MethodsTen patients with renal subcapsular hematoma and diffuse cortical hemorrhage were reviewed. Nine of the 10 had undergone procedures (nephrostomy, n = 4; biopsy, n = 4; embolization of a cerebral aneurysm, n = 1) and 1 patient was receiving oral anticoagulation. Computed tomography (CT), angiography, and embolization of bleeding sites were performed in all patients. ResultsCT and angiography revealed subcapsular hematoma with diffuse cortical hemorrhage at the level of the interlobar and/or arcuate branches. Total embolization of intrarenal arterial branches was required in 3 patients. Partial embolization, which also resulted in permanent functional loss, was required in 4. The functional loss was likely caused by the embolization procedure and the underlying renal disease. In these 4 patients, renal failure was demonstrated by scintigraphy in 3 cases and based on the need to start chronic hemodialysis in 1 case. In the remaining three patients, embolization did not compromise renal function. ConclusionsDiffuse cortical hemorrhage unrelated to the site of puncture may be seen in some cases of subcapsular hematoma. The cause is likely the laceration of transcortical capsular arteries secondary to enlargement of the subcapsular hematoma. In the present case series, embolization achieved hemorrhage control, but loss of renal function was observed in patients with underlying renal disease.