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

PURPOSE: To describe radiologic findings, embolization technique, and clinical outcomes in patients with renal subcapsular hematoma and diffuse cortical hemorrhage. MATERIALS AND METHODS: Ten 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. RESULTS: CT 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. CONCLUSIONS: Diffuse 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.

Kidneys from donors with incidental renal tumors: should they be considered acceptable option for transplantation?

BACKGROUND: The increase in the prevalence of end-stage renal disease in developed countries and the shortage of deceased donors has made it necessary to increase the graft pool by means of several strategies, such as live donation, non-heart-beating donors, and expanded criteria donors. Frequently, and because of the increasing acceptance of older donors, we find a higher percentage of incidental renal masses in these donors as a result of the inherent epidemiology of this disease. These kidneys can be considered suitable grafts after bench surgery to remove the tumor. METHODS: Retrospective analysis of donors with a diagnosis of incidental small renal mass before implantation and their corresponding recipients was performed between January 2007 and September 2012. All cases underwent an ex vivo tumorectomy with a preoperatory pathologic analysis. Recipients were followed up according to our standard renal tumor protocol. RESULTS: Eight donors with incidental renal mass were detected (four live and four deceased donors). The mean age was 47.8 years. Eleven transplantations were performed. Eight cases received the kidney after tumor exeresis, and three, the contralateral one. The recipient mean age was 53.8 years.The mean tumor diameter was 14.8 mm, with pathologic stages pT1a in seven cases and pT1b in one case (five clear cell renal carcinoma, two chromophobe type, and one lipoma). Surgical margins were negative. Mean follow-up was 32.34 months; none of the patients presented tumor recurrence, and all had correct renal function. CONCLUSIONS: Kidneys with small incidental tumors can be considered an option for kidney transplantation in selected patients.