Spontaneous renal allograft rupture complicated by urinary leakage: case report and review of the literature

Spontaneous renal rupture caused by factor VII deficiency: A case report

RATIONALE

Spontaneous renal rupture is an uncommon disease, it usually occurs after upper urinary calculi-related operation treatment or renal tumor. This disease caused by factor VII deficiency has rarely reported.

PATIENT CONCERNS

A 49-year-old woman came to our hospital with on the left flank pain and gross hematuria that had persisted for 10 days. The patient had no recent history of waist and abdominal trauma or surgical history recently.

DIAGNOSES

An outside computed tomography (CT) examination revealed left renal rupture before arriving at our hospital, but she was not treated. Further laboratory examination revealed that the patient condition was turned out to be hemophilia caused by factor VII deficiency.

INTERVENTION

We have used both internal and external drainage methods, and supplemented with coagulation factor.

OUTCOME

After 9 months of follow-up, it was observed that the left renal hematoma and urinary extravasation was completely absorbed.

LESSONS

Spontaneous renal rupture for hemophilia is a clinical emergency. When spontaneous renal rupture is associated with abnormal coagulation function, and the coagulation function cannot be corrected by conventional treatment, the possibility of hemophilia needs to be considered, and the type of hemophilia needs to be further defined. This case indicates a successful resolution of spontaneous renal rupture, it can provide guiding value for our clinical practice.

When Bodybuilding Goes Wrong—Bilateral Renal Artery Thrombosis in a Long-Term Misuser of Anabolic Steroids Treated with AngioJet Rheolytic Thrombectomy

Bilateral renal infarction is an extremely rare condition with only few cases reported in the literature. We present a case of bilateral renal infarction affecting an otherwise healthy 34 year old bodybuilder chronically misusing testosterone and stanozolol. The patient presented with severe flank pain mimicking renal colic and biochemical features of acute kidney injury. Diagnostic workup revealed thrombosis affecting both renal arteries. Subsequently, the patient underwent a percutaneous rheolytic thrombectomy with AngioJet catheter, along with catheter-directed thrombolysis. Right-sided retroperitoneal hematoma developed as an early complication, mandating surgical exploration and nephrectomy due to kidney rupture and the unstable condition of the patient. Intensive care and continuous renal replacement therapy were instigated until a gradual improvement of the patient status and a return of kidney function was achieved. No abnormalities were found in the cardiological and hematological evaluation. We believe this is a first report of bilateral renal infarction associated with anabolic steroid misuse in an otherwise healthy individual, and a first report of AngioJet thrombectomy in bilateral thrombosis of renal arteries. It stresses the importance of a thorough diagnostic workup of colic patients and emphasizes the need for sports medicine to reach out to amateur athletes with education on the harms of doping.

Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report

BACKGROUND

Spontaneous renal rupture is a rare disease in the clinic. The causes of spontaneous renal rupture include extrarenal factors, intrarenal factors, and idiopathic factors. Reports on infection secondary to spontaneous renal rupture and the complications of spontaneous renal rupture are scarce. Furthermore, there are few patients with spontaneous renal rupture who present only with fever.

CASE SUMMARY

We present the case of a 52-year-old female patient who was admitted to our hospital. She presented only with fever, and the cause of the disease was unclear. She underwent a contrast-enhanced computed tomography (CT) scan, which showed that the left renal capsule had a crescent-shaped, low-density shadow; the perirenal fat was blurred, and exudation was visible with no sign of calculi, malignancies, instrumentation, or trauma. Under ultrasound guidance, a pigtail catheter was inserted into the hematoma, and fluid was drained and used for the bacterial test, which proved the presence of Klebsiella pneumoniae. Two months later, abdominal CT showed that the hematoma was absorbed, so the drainage tube was removed. The abdominal CT was normal after 4 mo.

CONCLUSION

Spontaneous renal rupture due to intrarenal factors causes a higher proportion of shock and is more likely to cause anemia.

Subcapsular Renal Hematoma in Simultaneous Pancreas Kidney Transplantation

Subcapsular renal hematoma (SRH) is a challenging condition, which may jeopardize kidney function or constitute a life-threatening event. This is particularly true in single-kidney patients, such as kidney-transplant recipients. SRH may exert an excessive pressure on the surrounding parenchyma, thus resulting in hypoperfusion and ischemia, with high risk of acute kidney failure and graft loss. Moreover, SRH may precede an overt renal rupture with subsequent hemorrhage and hemodynamic instability. The indication to an interventional management for this condition is still a matter of debate, with some authors advocating the high possibilities of spontaneous resolution and others advocating the high-risk of graft loss and even internal bleeding in case of overt renal rupture. Herein, we report the case of a 51-year-old simultaneous pancreas-kidney transplantation recipient who presented a SRH following a mild trauma. The therapeutic choices were carefully balanced on the specific case, and the conservative management proved successful.

Temporary Renal Artery Clamping With Hemostatic Materials in Diffuse Type of Spontaneous Renal Allograft Rupture: A Case Report

BACKGROUND

Several surgical strategies have been introduced for spontaneous kidney rupture. Herein, we report on a case in which temporary artery clamping with hemostatic materials was performed.

CASE PRESENTATION

A 52-year-old man underwent renal transplant from a living donor (his 20-year-old son). Spontaneous allograft rupture occurred 6 days after transplant. He developed severe abdominal pain, hypotension, and mental changes. His blood hemoglobin level was 3.6 g/dL, which was indicative of severe hemorrhage. Immediate re-exploration revealed a large hematoma in the iliac fossa and that the renal allograft had ruptured, with multiple fracture lines on the entire surface. Because of diffuse surface rupture, surgical suture was not attempted. For manual compressive hemostasis, temporary artery clamping with hemostatic materials was performed. First, we identified the graft artery for temporary clamping, similar to the method in partial nephrectomy. Second, at the time of temporary clamping, the hemostatic matrix was sprayed on the surface of the renal graft. Third, we compressed the whole renal parenchyma with both hands and a dry pad for 5 minutes. After removing the clamp, successful bleeding control was confirmed. Finally, the graft was wrapped with oxidized cellulose. Renal biopsy in the operating room revealed the cause of rupture as acute rejection type IIB.

CONCLUSION

Spontaneous renal allograft rupture is a rare but serious complication. When surgical suture is not appropriate for the repair of the ruptured allograft, temporary artery clamping with hemostatic materials can be considered an alternative.