Spontaneous renal hemorrhage: a clinical analysis of 50 patients / 中华肾脏病杂志

ABSTRACT

Objective:To provide clinical experience for the diagnosis and treatment of spontaneous renal hemorrhage through retrospective analysis of clinical features, imaging manifestations, underlying causes, treatment , and prognosis of spontaneous renal hemorrhage. Methods:By searching hospital information system, medical records scanning system, department of the interventional vascular surgery registry system, and picture archiving and communication systems, the patients with spontaneous renal hemorrhage admitted to Peking University First Hospital between January 1, 2000 to April 10, 2020 were enrolled. The clinical manifestations, investigations, imaging features, treatment, and prognosis of patients were retrospectively reviewed. The diagnostic efficiency and the accuracy of etiological diagnosis of renal hemorrhage by imaging examinations such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography were compared and evaluated.Results:A total of 50 patients with 51 events of spontaneous renal hemorrhage were enrolled in the study. Laboratory tests showed hemoglobin was (103.3±29.4) g/L. The most common clinical features were flank or abdominal pain (48 cases, 96.0%), fever (17 cases, 34.0%), nausea (10 cases, 20.0%), vomiting (9 cases, 18.0%), and gross hematuria (4 cases, 8.0%). Nine patients (18.0%) experienced hypovolemic shock (systolic pressure<90 mmHg). With an initial assessment of the imaging method, the diagnostic accuracy of bleeding was 98.0%(49/50), yet the accuracy of underlying causes was 56.0%(28/50). The diagnostic accuracy of bleeding was 100.0%(25/25) by non-contrast abdominopelvic CT. The most common cause of spontaneous renal hemorrhage syndrome was renal tumors (27 cases, 54.0%), among which angiomyolipoma occurred most frequently (20 cases, 40.0%). Other causes included renal cyst (10 cases, 20.0%), autoimmune diseases (4 cases, 8.0%), bleeding diathesis (3 cases, 6.0%), and idiopathic renal hemorrhage (6 cases, 12.0%). Twelve patients (24.0%) received conservative management, 29 patients (58.0%) underwent interventional embolization therapy, and 11 patients (22.0%) received nephrectomy. The success rate on first embolization therapy was 86.2%(25/29), and approximately 13.8%(4/29) required second embolization therapy or nephrectomy.Conclusions:Spontaneous renal hemorrhage has no specific clinical features and is easy to be underdiagnosed or misdiagnosed. Non-contrast CT scan has a high diagnostic value for renal bleeding. Comprehensive judgement consisting of clinical features, laboratory tests, imaging manifestations and pathological examinations should be relied on for finding the underlying causes. Prompt diagnosis and management can guarantee a better prognosis.