RESUMEN
Spontaneous renal rupture is a rare clinical condition characterized by spontaneous bleeding in the renal subcapsular and perinephric spaces in patients without a history of trauma. It occurs mainly in pathologic kidneys and after some renal surgeries. We report a 40-year-old male patient admitted with a diagnosis of gallstones with cholecystitis due to fever and abdominal pain after unilateral ureteral calculi. The patient developed delayed right renal rupture hemorrhage during treatment, controlled after selective arterial embolization (SAE). Still, the patient developed spontaneous left renal rupture due to a systemic inflammatory response. Finally, the patient's life was saved after several selective embolizations of the renal artery. We retrospectively analyzed this case to improve our understanding of the disease.
RESUMEN
Spontaneous renal rupture (SRR) with retroperitoneal hemorrhage is an extremely rare medical emergency and is rather challenging for the surgical team. Management of SRR often requires surgical intervention and nephrectomy as it is life-threatening. Antiphospholipid syndrome (APLS) is an autoimmune disease that affects several organs, including kidneys, causing significant abnormalities. Current data suggest that APLS can result in renal artery stenosis, renal vein thrombosis, arterial hypertension, thrombotic microangiopathy, and antiphospholipid syndrome nephropathy where there is renal involvement. Here, we report the case of a 49-year-old man who presented to the Emergency Department with sudden-onset abdominal pain in the context of retroperitoneal bleeding due to SRR. The patient developed hemodynamic instability and underwent a total nephrectomy. The surgical specimen revealed APLS-related lesions. Serological tests confirmed the diagnosis of APLS, which was managed with acenocoumarol and hydroxychloroquine. Since then, he has not experienced any thromboembolic or hemorrhagic episodes. This article aims to present for the first time a case of SRR as the first presentation of APLS as well as to analyze the possible associated mechanisms.
RESUMEN
Spontaneous or non-traumatic rupture of the renal tract is an infrequent presentation, and it is most frequently caused by ureteric obstruction. Rupture could occur at any level of the upper urinary tract. However, it is most common at the renal calyces and complications that could arise include; urinoma, and or hematoma collection which could progress to abscess formation and sepsis. We report a 77-year-old male patient who attended the emergency department following referral from his general practitioner with a 6-day history of progressively worsening left sided abdominal pain. Due to his co-morbidities, presenting blood pressure and age, he was suspected of having an aortic dissection or ruptured abdominal aortic aneurysm and subsequently had a CT (computed tomography) Angiogram. This showed extravasation of contrast from the left kidney with a 12 mm obstructing vesico-ureteric junction calculus necessitating urgent urology referral and prompt review. He was worked up for a ureteric double J stent insertion, however, the procedure was unsuccessful due to complex multiple urethral strictures. The patient subsequently had a nephrostomy inserted and was planned for optical urethrotomy, rigid cystoscopy, rigid/flexible ureteroscopy, and laser stone fragmentation of left obstructing vesico-ureteric junction calculus.
RESUMEN
Spontaneous renal parenchymal rupture is a rare clinical emergency. The formation of benign and malignant tumors is the most common underlying cause of spontaneous rupture of renal parenchyma. To the best of our knowledge, 15 cases of renal parenchymal rupture have been reported to date. This report describes a rare case of renal parenchyma rupture in the lower left kidney caused by kidney calculi. Furthermore, previously published cases and articles were reviewed. The patient underwent four extracorporeal shockwave lithotripsy procedures within 2 years. The renal parenchyma rupture caused by the stones was successfully treated by removing the stones and repairing the kidney. However, a large hematoma was discovered around the lower pole of the left kidney, suggesting the possibility of a renal tumor. Therefore, radical nephrectomy was performed. Postoperative pathology revealed the lesion to be consistent with an intrarenal stone, where no malignancy, infection or vascular disease was observed. The present case highlights the requirement to also take into account the patient's clinical history in cases where imaging cannot completely identify the underlying cause of renal parenchymal rupture. Accurate identification of the underlying etiology of spontaneous renal rupture may determine the best treatment for the patient. The purpose of the present report is to facilitate the identification of the disease and reduce the rate of clinical misdiagnosis.
RESUMEN
Spontaneous intraperitoneal renal rupture with urinoma formation in fetuses is an unusual condition that is caused by upper or lower urinary tract obstruction. We report the case of a neonatal male infant who presented with a spontaneous intraperitoneal right renal rupture accompanying ipsilateral ureterovesical junction obstruction (UVJO). Fetuses with UVJO accompanying contralateral multicystic dysplastic kidney should be observed carefully because of the risk of spontaneous renal rupture.
RESUMEN
Spontaneous subcapsular renal haematoma is a rare condition with wide range of presentation; it poses a dilemma for diagnosis and management. We present a case of 38-year-old female who presented with right flank pain (continuous, dull aching) for a week with right renal angle tenderness and high blood pressure (though she was not known hypertensive). On imaging, there was right renal subcapsular collection. She did not respond to conservative management except that her blood pressure was controlled with single drug Angiotensin Converting Enzyme (ACE) inhibitor. Right double J stent was placed (in view of urinoma) and patient was followed for six weeks. Repeat computed tomography scan showed persistence of right renal subcapsular collection but the cause was not found. Except hypertension, no definitive cause for the condition could be found. Patient was intervened surgically with right subcostal exploration and subcapsular haematoma was found and drained. Patient was asymptomatic thereafter.
RESUMEN
We describe our experience with a case of spontaneous renal rupture. A 43-year-old man visited our hospital with a chief complaint of left back pain with no identifiable triggering factors. A CT scan showed a rupture involving the left renal parenchyma and hematoma around the kidney. However, there were no apparent causes of the renal rupture, such as tumors and vascular lesions. Based on these findings, he was diagnosed with spontaneous renal rupture. Due to progression of anemia during the course, he underwent transcatheter arterial embolization of the kidney. He continues to undergo imaging examinations on a regular basis and has shown no development of apparent neoplastic lesions for 13 months.
RESUMEN
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.