Renal Subcapsular Hematoma Research Articles

Subcapsular Renal Hematoma: Three Case Reports and Literature Reviews

Subcapsular renal hematoma (ScRH), albeit not a common entity in clinical practice, is a life-threatening condition when it is stopped naturally by the tamponade effect of the renal capsule. Renal tumors, renal vascular diseases, trauma and iatrogenic reasons are held responsible in the etiology. The affected patients present to emergency departments with the symptoms and sings comprising sudden onset flank pain, abdominal tenderness and hematuria. We presented in this paper three case reports related to ScRHs; the first with spontaneous ScRH; the second with the ScRH induced by anticoagulation therapy; and, the third with traumatic ScRH. We implemented conservative treatment in all of the patients. Moreover, we aimed, along with the current literature, to commence a discussion on the etiological reasons, the clinical presentation and the treatment approaches with regard to ScRH.

Spontaneous renal subcapsular hematoma in a very old patient presenting with shock and severe anemia: An uncommon oral anticoagulant treatment‐related complication

Geriatrics & Gerontology InternationalVolume 12, Issue 1 p. 166-168 Spontaneous renal subcapsular hematoma in a very old patient presenting with shock and severe anemia: An uncommon oral anticoagulant treatment-related complication Sandra Gori, Sandra Gori Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorLuca Masotti, Luca Masotti Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorDaniela Cannistraro, Daniela Cannistraro Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAnnaMaria Bellizzi, AnnaMaria Bellizzi Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAnnalisa Mannucci, Annalisa Mannucci Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorFabio Paolo Scotto, Fabio Paolo Scotto Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAlessandro Pampana, Alessandro Pampana Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this author Sandra Gori, Sandra Gori Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorLuca Masotti, Luca Masotti Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorDaniela Cannistraro, Daniela Cannistraro Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAnnaMaria Bellizzi, AnnaMaria Bellizzi Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAnnalisa Mannucci, Annalisa Mannucci Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorFabio Paolo Scotto, Fabio Paolo Scotto Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this authorAlessandro Pampana, Alessandro Pampana Internal Medicine, Cecina Hospital, Cecina, ItalySearch for more papers by this author First published: 21 December 2011 https://doi.org/10.1111/j.1447-0594.2011.00733.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume12, Issue1January 2012Pages 166-168 RelatedInformation

Bilateral spontaneous retroperitoneal bleeding in a patient on nimesulide: a case report

IntroductionSpontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage.Case presentationA 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful.ConclusionThis is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision

BackgroundThe aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004.MethodsThe subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment.ResultsAt 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each.ConclusionsESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Subcapsular renal haematoma after holmium:yttrium‐aluminum‐garnet laser ureterolithotripsy

To report the incidence, risk factors, and outcomes of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser to treat ureteric stones. Prospective data from 2848 URSLs performed between January 2003 and September 2010 were retrospectively analysed. In all 11 patients were identified as having a SRH after URSL if they had persistent severe ipsilateral flank pain or a palpable mass within a day of surgery, or presented with radiographic evidence of a SRH. Risk factors for the development and course of the SRH were reported. Of the 2848 consecutive patients treated with URSL using Ho:YAG laser, 11 (0.4%) developed a SRH after surgery. Patients who developed a SRH had larger stones (1.4 vs 0.9 cm, P < 0.001), more severe ipsilateral hydronephrosis (P < 0.001), longer operation duration (41 vs 33 min, P < 0.001), and higher perfusion pressure of hydraulic irrigation (176.8 vs 170.2 mmHg, P < 0.001) than patients who did not develop a SRH. Patient age, sex, body mass index, presence of diabetes mellitus, history of urolithiasis and hypertension, presence of multiple stones, stone location and flow rate of hydraulic irrigation were not statistically different in patients who did or did not develop a SRH. Most patients were managed conservatively, with no further intervention or with a flank drain, until the SRH resolved. Overall, in three patients the SRH resolved with no further intervention, six patients were treated with a drain only, and two patients had open surgery within a day of presenting with SRH. The rate of development of SRH after URSL is very low. Most patients who present with a SRH after URSL, can be treated conservatively with no intervention or with a drain only.

CT-guided Navigation of Percutaneous Hepatic and Renal Radiofrequency Ablation under High-frequency Jet Ventilation: Feasibility Study

Purpose Computed tomography (CT)–guided navigation during percutaneous radiofrequency (RF) ablations of liver and kidney lesions is hampered by respiratory motion and time-dependent lesion conspicuity after contrast agent injection. Therefore, target immobilization by general anesthesia with high-frequency jet ventilation (HFJV) instead of conventional ventilation (CV) with repeated breath-holds may facilitate and speed up navigation of RF ablation probes. Materials and Methods Nineteen consecutive patients who underwent percutaneous RF ablation of liver (n = 9) or renal tumors (n = 10) with CT guidance under HFJV (n = 9) or CV (n = 10) were included. The choice of the anesthesiologic technique was left to the discretion of the interventionalist. Complexity of the intervention (ie, number of lesions ablated per session, conspicuity of the lesion on nonenhanced CT, and access pathway), volume of the ablated tissue, radiation exposure, and complications were compared between the HFJV and CV groups. Results In this feasibility study, a statistically significant radiation dose reduction ( P < .05) was noted in the HFJV group compared with the CV group for liver and renal RF ablation. No complications were observed in the HFJV group, whereas renal subcapsular hematoma (n = 2) and pulmonary embolism (n = 1) occurred in the CV group. Conclusions Percutaneous CT-guided navigation of RF ablation probes under HFJV is feasible and safe. It might be advantageous for the treatment of complex kidney and liver tumors, allowing less irradiation exposure to the patient and the interventional radiologist.

Spontaneous subcapsular renal hematoma: A case report and review of literature

Spontaneous subcapsular renal hematoma is not a common entity. We report a 38-year-old lady presenting with sudden onset right flank pain with uncontrolled hypertension and she was found to have subcapsular collection in the right kidney on ultrasonography. Finding was confirmed on computed tomography. Except hypertension, no particular cause for the condition could be found. Symptoms and size of the collection decreased on conservative treatment. They completely disappeared on ultrasonography at 6 months follow-up. She was asymptomatic at 18 months follow-up.

Spontaneous perinephric haemorrhage and acute renal failure in pregnancy due to cocaine intoxication.

Cocaine abuse may contribute to the diverse forms of renal injury. We report a case of a pregnant woman who developed a large subcapsular renal haematoma after cocaine intoxication at 18-week gestation. She stabilized on conservative management and presented again at 29-week gestation with pre-eclampsia, acute renal failure and fetal demise. She required caesarean section delivery and intensive antihypertensive therapy to control severe pre-eclampsia associated with cocaine intoxication. This case is unique in that it is the first report of cocaine intoxication in pregnancy complicated by subcapsular haemorrhage. We discuss the possible mechanisms for the occurrence of this complication.

Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.

Conservative management of an extensive renal graft subcapsular hematoma arising during living donor nephrectomy. Role of Doppler sonographic posttransplant follow‐up

We report a case of subcapsular hematoma (SH) of a kidney graft arising during minimal-incision living-donor nephrectomy. SH covered at least two-thirds of the cortical surface. Capsulotomy was not done because it was deemed too risky. In the immediate postoperative period, a rapid deterioration of graft function was observed associated with Doppler sonographic evidence of graft compression. However, in the following days, spontaneous resolution of SH and progressive improvement of Doppler findings was observed, which preceded full recovery of graft function. Conservative management seemed a valid approach of this complication in this case where Doppler sonography proved essential for the follow-up.

Spontaneous Bilateral Renal Subcapsular Hematoma as a Possible Complication of Myeloproliferative Disorders

A 64-year-old male had bilateral renal subcapsular fluid accumulation evident on abdominal sonography performed during postoperative follow-up after surgery for a hepatoma. There were no clinical symptoms, and he had no history of trauma or receiving anticoagulant medication. Spontaneous bilateral renal subcapsular hemorrhage was diagnosed after a series of examinations. He did have an underlying myeloproliferative disorder (MPD), and had received incomplete cytoreductive treatment. Platelet aggregation in MPD is often abnormal, and both bleeding and hypercoagulation complications have been reported. Here we report a rare case of MPD with possible thrombohemorrhagic complications presenting as spontaneous bilateral renal subcapsular hematomas.

Renal endometriosis presenting with a giant subcapsular hematoma: case report

To describe a case of renal subcapsular hematoma due to renal endometriosis. Case report. Departments of Urology and Pathology, Baskent University Faculty of Medicine, Ankara, Turkey. A 46-year-old premenopausal woman was admitted with a left lumbar pain and mass. Ultrasonography and computerized tomography revealed a giant-sized renal subcapsular hematoma. Computerized tomography, percutaneous drainage catheter placement, surgical exploration, and excision of renal capsule. None. Histopathologic examination revealed endometriosis located beneath the fibrous renal capsule. Renal capsular endometriosis should be kept in mind among the causes of renal subcapsular hematoma.

Laparoscopic adrenalectomy: Troublesome cases

Among 143 cases of laparoscopic adrenalectomy carried out from 1993 to the present, 13 patients in whom the surgical manipulation presented problems were examined. Problems occurred due to the condition of the adrenal tumors themselves in six patients, whereas problems occurred due to the operative history in four patients. There were three patients with no operative history but with strong intraperitoneal adhesion. In patients with a history of laparotomy in other fields such as open cholecystectomy, gastrectomy or colostomy, operations were possible in most patients by examining the trocar site preoperatively. Patients with strong adhesion even without a history of surgery could be handled by full separation of the adhesion during surgery. In patients with bleeding in the adrenal tumors, large adrenal tumors, or tumors impacted in the liver, methods such as changing the sequence of separation procedures were required. In patients with a history of renal subcapsular hematomas due to extracorporeal shock wave lithotripsy (ESWL), it was not possible to understand the conditions of adrenal or perinephritic adhesion in preoperative imaging diagnosis, but resection was possible by changing the order of separation procedures and by using optimal instruments and devices. As with any surgery, including open surgeries, it is necessary to obtain knowledge on how to deal with variations in laparoscopic adrenalectomy to assure safe outcomes and to always consider effective methods for coping with unexpected difficulties.

A Page Kidney Case Report With Diastolic Flow Reversion in Doppler Ultrasonography

The renal compartment syndrome, also known as Page kidney, is due to external compression of the kidney, generally caused by a subcapsular hematoma resulting in hypertension and sometimes renal failure. It was first described in an experimental model reported by Page in 1939 based on cellophane wrapping around canine kidneys (1, 2). We present a Page kidney novel cause associated with the placement of a percutaneous nephrostomy tube in a renal allograft. A 60-year-old hypertensive man, with chronic ischemic cardiopathy and antiplatelet therapy with aspirin, presented chronic kidney disease. He received a cadaver kidney transplant with immediate renal allograft function and was immunosuppressed with prednisone, tacrolimus, and mycophenolate mofetil. One month later patient’s renal function declined. An ultrasound scan detected urinary tract dilatation. A pyelography revealed stenosis of the ureterovesical anastomosis, thus requiring placement of a percutaneous nephrostomy tube with appropriate diuresis through nephrostomy and recovery of baseline creatinine. Forty-eight hours after nephrostomy, he developed oliguria and his serum creatinine increased to 8.6 mg/dL. Ultrasound scan showed a 12×4.4 cm renal graft with a 8×2.9 cm subcapsular hematoma. Doppler ultrasonography revealed a spectral tracing with diastolic flow reversion and an increase in the resistance indexes. Both main artery and main vein were patent. CT scan exposed a subcapsular hematoma with a longitudinal diameter larger than 14 cm, which compressed the graft in its entirety. Hematoma’s percutaneous drainage was initially attempted. Twenty-four hours later, the patient underwent surgery for hematoma’s removal and repair of the ureterovesical stenosis. Postsurgery development was successful, with progressive increase of the diuresis and decrease of serum creatinine to basal line. Ultrasound and Doppler studies confirmed the disappearance of the hematoma and the recovery of normal spectral tracings with a decrease in the resistance indexes (Fig. 1). The patient remained normotensive with his usual antihypertensive medication.FIGURE 1.: (A) Doppler ultrasonography spectral tracing with diastolic flow reversion and an increase of the resistance indexes up to 1. (B) Doppler ultrasonography after surgery with spectral tracing normalized 68×68 mm.Page kidney is most frequently due to a renal trauma that results in a hematoma (3, 4), but there have been case reports in which renal compression is secondary to a perirenal limphocele or retroperitoneal paraganglioma (5, 6). In our patient, Page kidney derives from a renal subcapsular hematoma secondary to placement of a percutaneous nephrostomy tube. This procedure in kidney allograft is a novel cause, which in our knowledge has not yet been reported. Antiplatelet therapy may have promoted development of a hematoma following the procedure (7). Usual clinical findings in this syndrome include hypertension, which develops immediately because of direct compression of the renal parenchyma and renal failure, which is more common in patients with a single native kidney or a renal graft (3). Blood pressure levels did not increase in our patient, although renal failure was observed. Reversion of the diastolic flow in Doppler ultrasonography is suggestive of allograft venous thrombosis or severe renal parenchymal damage (8, 9) and this fact has not previously been described in Page kidney. Normalization of spectral tracings after surgery and renal function recovery suggests that diastolic flow reversion is due to renal allograft compartment syndrome, in addition to other known conditions and it could be useful in the differential diagnosis of such processes. Silvia Caldés Ana Fernández Maite Rivera Jose L. Merino Department of Nephrology Ramón y Cajal Universitary Hospital Madrid, Spain Raquel González Department of Urology Ramón y Cajal Universitary Hospital Madrid, Spain Yesika Amezquita Roberto Marcén Department of Nephrology Ramón y Cajal Universitary Hospital Madrid, Spain F. Javier Burgos Department of Urology Ramón y Cajal Universitary Hospital Madrid, Spain Joaquin Ortuño Department of Nephrology Ramón y Cajal Universitary Hospital Madrid, Spain

A case of right renal infarction and subcapsular hematoma that simultaneously developed after cardiac angiography

Of the several complications known to develop after cardiac catheterization, simultaneous acute renal infarction and renal subcapsular hematoma is rare. Here, the authors report a case of acute renal infarction with subcapsular hematoma that developed 4 hours after cardiac catheterization.

Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma

We describe a rare case of metastatic choriocarcinoma, which presented with acute left loin pain due to a subcapsular haematoma secondary to a bleeding renal metastasis. The renal metastasis was embolised to prevent further bleeding. To our knowledge, presentation of gestational trophoblastic tumour (GTT) with such symptoms has not been described in the recent literature. Our case illustrates that, although rare, non-gynaecological symptoms can be the first presentation of metastatic choriocarcinoma in the appropriate clinical settings. It also demonstrates that the acute bleed from a renal metastasis can be effectively managed by embolisation.

Subcapsular Renal Hematoma Complicating Acute Pyelonephritis

Subcapsular renal hematoma (SRH) is an extremely rare complication of acute pyelonephritis (APN). We report a case of SRH complicating APN with a ureteral stone, together with a review of the literature.

Subcapsular hematoma evacuation as a method of evaluating injured kidneys for transplant

Approximately one-third of organ donors in the United States are trauma victims. In general, kidneys with large subcapsular hematomas are not used for transplant because of the possibility of significant parenchymal injury. A large subcapsular renal hematoma may cause scarring resulting in renal parenchymal compression and development of the Page syndrome. To elucidate a successful method of evaluating kidneys subject to trauma, while also possibly preventing further damage and improving their function. Data were collected from the donor kidney pool of the New York Organ Donor Network from January 2006 through July 2007. Four kidneys during that period were determined to have significant subcapsular hematomas. Surgical intervention was undertaken and outcomes after transplantation were reviewed. Four of the kidneys underwent a surgical procedure to drain the subcapsular hematoma allowing assessment of the underlying renal parenchyma. All 4 of these kidneys were deemed transplantable. After transplantation, 3 of the 4 kidneys had immediate function and did not require dialysis. The remaining kidney was removed as a result of primary nonfunction. The described surgical intervention allows the transplant surgeon to accurately assess the extent of damage to a traumatized kidney while possibly preventing further damage to the kidney.

Subcapsular Hematoma Evacuation as a Method of Evaluating Injured Kidneys for Transplant

Approximately one-third of organ donors in the United States are trauma victims. In general, kidneys with large subcapsular hematomas are not used for transplant because of the possibility of significant parenchymal injury. A large subcapsular renal hematoma may cause scarring resulting in renal parenchymal compression and development of the Page syndrome. To elucidate a successful method of evaluating kidneys subject to trauma, while also possibly preventing further damage and improving their function. Data were collected from the donor kidney pool of the New York Organ Donor Network from January 2006 through July 2007. Four kidneys during that period were determined to have significant subcapsular hematomas. Surgical intervention was undertaken and outcomes after transplantation were reviewed. Four of the kidneys underwent a surgical procedure to drain the subcapsular hematoma allowing assessment of the underlying renal parenchyma. All 4 of these kidneys were deemed transplantable. After transplantation, 3 of the 4 kidneys had immediate function and did not require dialysis. The remaining kidney was removed as a result of primary nonfunction. The described surgical intervention allows the transplant surgeon to accurately assess the extent of damage to a traumatized kidney while possibly preventing further damage to the kidney.

腎被膜下血腫を発症した高齢者骨髄異形成症候群の1例

An 82-year old, elderly woman who had been found to have myelodysplastic syndrome (MDS)-refractory anemia three years previously, complained of fever and abdominal pain, and was hospitalized. Abdominal CT images resulted in a diagnosis of renal subcapsular hematoma thus conservative treatment, including blood transfusions of platelet, was initiated. However, the hematoma enlarged, and she also had a spiking fever. After the hematoma was punctured and we drained an abscess caused by Klebsiella Pneumoniae, the hematomal legion subsided, and the inflammatory symptoms improved. There has been no recurrence for more than one year. This case is thought to be the first in which a renal subcapsular hematoma developed with MDS. Although the cause of the renal subcapsular hematoma has not yet been identified, the vulnerability due to aging of the small vessels along with a decrease in the number of platelets have been considered as contributing factors in this elderly case.