Delayed bilateral spontaneous renal rupture after surgery for unilateral upper ureteral calculi: a case report.

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.

Retroperitoneal Hemorrhage Due to Spontaneous Renal Rupture as the First Presentation of Antiphospholipid Syndrome: A Case Report.

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.

Spontaneous renal rupture due to renal calculi: A case report and literature review.

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.

Spontaneous renal tract rupture from obstructing vesico-ureteric junction calculus.

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.

Spontaneous intraperitoneal renal rupture with urinoma formation in the fetus.

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.

Spontaneous Subcapsular Renal Haematoma : A Case Report.

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.

[SPONTANEOUS RENAL RUPTURE TREATED BY TRANSCATHETER ARTERIAL EMBOLIZATION: A CASE REPORT].

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.

Spontaneous subcapsular renal hematoma: A case report and review of literature.

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.

Spontaneous Renal Rupture in Patients on Chronic Hemodialysis / 대한신장학회잡지

BACKGROUND: Because of high incidence of acquired renal cyst and renal malignancy, it is suggested that spontaneous renal rupture more frequently occurs in patients receiving long-term hemodialysis than general population. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture in hemodialysis patients. METHODS: This retrospective study enrolled 12 hemodialysis patients who developed spontaneous renal rupture. We investigated primary renal disease, duration of dialysis, clinical symptoms and signs, radiologic findings, treatment modalities, and histologic findings. RESULTS: The mean age of the patients was 54+/-10 years old and the number of male was 9. Primary renal disease consisted of autosomal dominant polycystic kidney disease (PCKD) (n=5), chronic glomerulonephritis (n=2), diabetic nephropathy (n=1), hypertensive nephropathy (n=1), unknown cause (n=3). Presenting symptoms and signs were sudden onset of flank pain in 9 patients and gross hematuria with mild flank pain in 3 patients. Mean duration from initiation of hemodialysis to development of spontaneous renal rupture was 53+/-36 months. Abdominal computed tomography showed subcapsular or perinephric hematoma in all patients. Of the 7 non-PCKD patients, 6 patients had multiple acquired renal cysts. Surgical exploration was undertaken in 9 patients. Pathologic examination demonstrated small sized-renal cell carcinoma in 2 of 9 patients. Three patients were only treated with conservative management including blood transfusion. All 12 patients recovered without recurrence. CONCLUSION: This study demonstrated that genetic or acquired renal cyst was an important cause of spontaneous renal rupture in hemodialysis patients and presenting manifestations were sudden onset of flank pain and gross hematuria.

Spontaneous Rupture of the Kidney Due to Metastatic Choriocarcinoma during Pregnancy / 대한비뇨기과학회지

A spontaneous rupture of the kidney due to a metastatic choriocarcinoma, which is associated with a normal pregnancy, is very rare. A 33-year-old female patient presented with sudden colicky right flank pain on the 5th day after a Cesarian Section. An abdominal CT scan showed evidence of a right renal rupture with a perirenal hematoma. Under the impression of a spontaneous rupture of right kidney, an exploratory laparotomy with a radical nephrectomy was performed. The pathologic findings revealed a renal parenchymal rupture due to a metastatic choriocarcinoma.

Idiopathic Spontaneous Renal Rupture

Spontaneous renal rupture is a rare, but important, clinical problem that heralds a variety of kidney abnormalities. Tumors are the most common cause, followed by vascular disease, infection, nephritis and blood dyscrasia. In some cases, no underlying abnormality of the kidney can be found. The patients usually present with an acute onset of flank pain, a tender mass, and common symptoms and signs of shock. In most cases rapid surgical intervention is necessary and nephrectomy remains the treatment of choice in cases of a ruptured tumor. A 47 year-old female, who had been in good health previously, was hospitalized because of a sudden onset of left flank pain for one day. There was no history of trauma. Physical examination revealed marked tenderness and guarding over the left flank abdomen. A perirenal hematoma on the left side was seen with abdominal sonography. Computerized tomography demonstrated a large perirenal hematoma and a kidney rupture caudally. Selective renal angiography demonstrated an active bleeding over the lower pole, so a coil embolization and nephrectomy were performed. The histological examination of the kidney revealed no underlying abnormality. We report a case of idiopathic spontaneous renal rupture, along with a literature review.

Two cases of spontaneous rupture of the kidney / 대한비뇨기과학회지

Spontaneous rupture of the kidney with subcapsular or perinephric hemorrhage usually occurs secondary to various kinds of underlying diseases such as benign malignant tumor. vascular disease and infection etc. We experienced 2 cases of spontaneous rupture of the kidney secondary to renal cell carcinoma in a 44-year-old female and adult Wilms' tumor in a 17-year-old male.

A case of adult Wilms' tumor associated with spontaneous renal rupture / 대한비뇨기과학회지

Wilms' tumor is composed of a mixture of epithelial, stromal and blastematous elements in varing proportions. Adult Wilms' tumor, unlike that of childhood is a rare disease. Spontaneous rupture of the kidney with subcapsular or perirenal hematoma also is rarely seen in malignant renal tumor. A case of adult Wilms' tumor in 65-year old female is here reported, associated with spontaneous renal rupture, which was treated with radical nephrectomy and chemotherapy (vincristine, actinomycin D and doxorubicin).

Two Cases of Spontaneous Rupture of the Kidney / 대한비뇨기과학회지

Two cases of spontaneous kidney rupture with literatural review was presented at first in Korea. 1) 56 years male patient and 25 years male patient admitted to our department of Urology through Emergency Room after onset of 2 and 1 day. after treatment at local clinic. 2) Chief complaints were one side flank pain which was followed by total gross hematuria. 3) Preoperative diagnoses were kidney rupture due to necrotic pelvic tumor in 56 years male and hypernephroma in 25 years male patient. 4) Operation was procedured at 8 days and 4 days after admission respectively. 5) The operative procedure were nephrectomy in both cases. 6) The pathological diagnoses were pelvis rupture due to renal stone and parenchymal rupture due to renal infarction in each case.