Bilateral spontaneous renal
rupture is a rare event that has been documented in only a few
reports. We
report a spontaneous, but not simultaneous
rupture of both
kidneys in a 64-year-old man with
end-stage renal disease who had been treated with
hemodialysis for 78 months. He complained of sudden
left flank pain. Abdominal computed
tomography (CT) revealed a huge perirenal
hematoma with multiple renal
cysts. The
patient underwent an urgent left
nephrectomy and was diagnosed as multiple acquired renal
cysts with
rupture and focal incidental
papillary renal cell carcinoma. Twenty-two days after the left
nephrectomy, he complained of sudden
right flank pain and abdominal CT showed another massive perirenal
hematoma. The
patient underwent a right
nephrectomy and was diagnosed as renal
cyst rupture with perirenal
hemorrhage. However, there was no evidence of
renal cell carcinoma in the right
kidney.
Postural hypotension and frequent hypotensive episodes developed during
hemodialysis several months after both
nephrectomies. He was diagnosed as
primary adrenal insufficiency with rapid
adrenocorticotropic hormone (
ACTH) stimulation test and the level of
plasma ACTH and was treated with
prednisolone and
fludrocortisone. The
patient died of acute
myocardial infarction 32 months after bilateral
nephrectomies.