Our experience in emergency treatment of renal haemorrhage. / Nuestra experiencia en el tratamiento urgente de la hemorragia renal.

ABSTRACT

INTRODUCTION: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVES: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved.