Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience.

PURPOSE: Transarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure. METHODS: All the RTE procedures performed in our Interventional Radiology unit in last 10 years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30 days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified. RESULTS: Over a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm3 measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135 mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR < 3.350 ml/min, and a post-procedural reduction of platelet count (PLT) > 46.50 × 103/mmc showed a significantly higher rate of clinical failure. CONCLUSION: RTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored.

Acute pulmonary embolism and severe post thrombolysis renal bleeding, two deadly complications following mini-percutaneous nephrolithotomy: a rare case report.

BACKGROUND: Acute pulmonary embolism and severe renal bleeding are two lethal postoperative complications, but there has been no report that involves both of them after mini-percutaneous nephrolithotomy. CASE PRESENTATION: A 62-year-old woman was admitted to our hospital with extremely severe hydronephrosis and multiple right renal calculi. After thorough examination, she received prone-position mini-percutaneous nephrolithotomy under spinal anaesthesia. Three days postoperatively, the patient complained of chest pain and dyspnea. Computed tomography pulmonary angiogram (CTPA) showed multiple embolisms in the left pulmonary artery and its branches. Symptoms were relieved after anticoagulant and thrombolysis therapy. On the 6th postoperative day, the patient developed shortness of breath, computed tomography angiography (CTA) showed massive hemorrhage in the right kidney, diffused contrast medium in the middle and lower part of the right kidney was seen during digital substraction angiography (DSA). Superselective right renal artery embolization (SRAE) was then applied using coil to occlude the responsible artery. The patient generally recovered under conscientious care and was approved to be discharged 26 days postoperatively. CONCLUSIONS: This is the first case that involved both acute pulmonary embolism and severe post thrombolysis renal bleeding. The importance of D-dimer in the prediction and early detection of pulmonary embolism should be noted. For post thrombolysis renal bleeding, SRAE is considered as a reliable treatment.

Haematuria is not a risk factor of hypertension or renal impairment in patients with haemophilia.

INTRODUCTION: An increased prevalence of hypertension has been reported in patients with haemophilia compared to the age-matched general population, although the causes were unclear. To date, there has been limited data implicating haemophilia-specific risk factors such as renal bleeding. AIM: This two-centre prospective cohort study aimed to assess the prevalence of gross/microscopic haematuria, and the associations between haematuria, blood pressure and renal function. METHODS: Of 135 adult males, with mild to severe haemophilia followed by the British Columbia and University of California San Diego Hemophilia Treatment Centers were included. Screening urinalysis and microscopy were performed during all routine visits. Haematuria was defined as history of gross haematuria or >3 red blood cells per high-power field on microscopy in the absence of urinary tract infections. Logistic regressions were used to examine the significance of haematuria and other potential hypertension risk factors. RESULTS: The prevalence of hypertension was 44%, of whom 31% achieved adequate blood pressure control. Despite the high prevalence of haematuria (34%), renal dysfunction was rare. On univariate analysis, age, diabetes, dyslipidemia and obesity were associated with hypertension. On multivariate analysis, only age remains as a significant predictor of hypertension. Haematuria was not associated with hypertension, renal insufficiency or haemophilia severity. CONCLUSION: In this cohort, hypertension and haematuria were prevalent while renal disease was rare. Haematuria was not associated with a diagnosis of hypertension or renal dysfunction. Larger prospective studies are needed to elucidate the mechanisms for increased prevalence of hypertension in haemophilia.

Renal bleeding: imaging and interventions in patients with tumors.

In patients with cancer, spontaneous renal bleeding can stem from a range of underlying factors, necessitating precise diagnostic tools for effective patient management. Benign and malignant renal tumors are among the primary culprits, with angiomyolipomas and renal cell carcinomas being the most common among them. Vascular anomalies, infections, ureteral obstructions, and coagulation disorders can also contribute to renal-related bleeding. Cross-sectional imaging techniques, particularly ultrasound and computed tomography (CT), play pivotal roles in the initial detection of renal bleeding. Magnetic resonance imaging and CT are preferred for follow-up evaluations and aid in detecting underlying enhancing masses. IV contrast-enhanced ultrasound can provide additional information for active bleeding detection and differentiation. This review article explores specific disorders associated with or resembling spontaneous acute renal bleeding in patients with renal tumors; it focuses on the significance of advanced imaging techniques in accurately identifying and characterizing renal bleeding in these individuals. It also provides insights into the clinical presentations, imaging findings, and treatment options for various causes of renal bleeding, aiming to enhance the understanding, diagnosis, and management of the issue.

Serious Hemorrhagic Complications After Successful Treatment of Hematopoietic Stem Cell Transplantation-Associated Thrombotic Microangiopathy With Defibrotide in Pediatric Patient With Myelodysplastic Syndrome.

Background: Transplant-associated thrombotic microangiopathy (TAM) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT). There is some evidence of endothelial injury playing a significant role in TAM development. The efficacy of defibrotide was demonstrated for prophylaxis and treatment of another HSCT-associated endothelial damage syndrome-liver veno-occlusive disease. The data for defibrotide usage in TAM are limited. Case Description: A 9-year old boy underwent HSCT from a matched unrelated donor for monosomy seven-associated myelodysplastic syndrome treatment. A myeloablative preparative regimen and post-transplant immunosuppression with cyclophosphamide on days +3 and +4 and a combination of tacrolimus with mycophenolate mofetil from day +5 were used. From day +61, sustained fever with progressive neurologic impairment and no evidence of infection was observed. On day +68, the patient developed severe TAM with acute kidney injury requiring renal replacement therapy (RRT). Defibrotide therapy 25 mg/kg/day was administered for 7 days with resolution of TAM symptoms. It was followed by multiple hemorrhagic episodes-epistaxis, hemorrhagic cystitis, and renal hemorrhage, which are presumed to be the complications of defibrotide therapy. Conclusion: Defibrotide could be an effective therapy for TAM, but adequate doses, duration of therapy, and drug safety profile both for pediatric and adult patients need to be evaluated by randomized prospective studies.

The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding.

INTRODUCTION: This study was designed to assess the clinical factors associated with the development of acute kidney injury (AKI) in patients undergoing endovascular treatment during the course of severe renal bleeding. METHODS: A retrospective analysis was performed of 36 consecutive patients who were treated endovascularly between January 2006 and December 2016 for anemia caused by iatrogenic (26 pts) or posttraumatic (10 pts) renal bleeding. Typical patient data, baseline, and postprocedural blood parameters were evaluated. As a predictor of AKI occurrence, SCr0 > 1.5 mg/dL, eGFR < 60 ml/min/1.73 m2, and Mehran score were evaluated. RESULTS: Fourteen patients (39%) developed AKI after CM injection. Time of hospitalization (p = 0.02), hypotension (p = 0.005), dialysis (p = 0.05), blood transfusions (p = 0.028), amount of blood received (p = 0.003), red blood units > 3 (RBU) (p = 0.032), and CM > 150 ml (p = 0.014) were related to AKI occurrence. The Mehran score may be used as a predictor of AKI occurrence (p = 0.022). The SCr > 1.5 mg/dL and eGFR < 60 ml/min/1.73 m2 were not statistically significant. Selective renal embolization (mean 34% loss of renal tissue) does not lead to AKI. CONCLUSIONS: Hypotension, anemia requiring blood transfusion, and administration of CM exceeding 150 ml poses higher risk of AKI development, which leads to longer hospital stay and need of dialysis. The Mehran score may be used as predictor of AKI occurrence. Up to one third of the kidney was embolized with no AKI linked to the procedure. The concern of AKI occurrence should not be a cause of delay of endovascular treatment.

Polyclonal gammopathy related to renal bleeding in a peritoneal dialysis patient.

Polyclonal gammopathy represents the diffuse activation of B cells and is usually related to inflammation or immune-related diseases. However, the mechanisms leading to polyclonal gammopathy are essentially speculative. Generally, infectious, inflammatory, or various other reactive processes may be indicated by the presence of a broad-based peak or band in the gamma region on serum protein electrophoresis results. A 15-year-old girl, who had been receiving peritoneal dialysis, presented with polyclonal gammopathy and massive gross hematuria. Renal artery embolization was performed, after which the continuous bleeding subsided and albumin-globulin dissociation resolved. This is a rare case of polyclonal gammopathy related to renal bleeding.