Renal pseudoaneurysm after core-needle biopsy of renal allograft successfully managed with superselective embolization

Im, Antonopoulos; Kg, Yamacake; Bc, Tiseo; Carnevale, Francisco César; Wc, Nahas

doi:10.1590/s1677-5538.ibju.2014.0315

Cited by 4 publications

(8 citation statements)

References 6 publications

(5 reference statements)

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“…RIP is a very uncommon but life-threatening condition. RIP after a percutaneous kidney biopsy is rare and often described in case reports [ 1 , 12 , 13 , 14 , 15 ]. One series of 72 percutaneous allograft biopsies estimated the incidence of RIP to be approximately 5% [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

Hansrivijit¹,

Gadhiya²,

Zelonis³

et al. 2021

Case Rep Nephrol Dial

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Late-onset retroperitoneal hemorrhage from renal intraparenchymal pseudoaneurysm (RIP) following a kidney biopsy is an extremely rare complication but should not be ignored, especially in high-risk populations. Here, we introduce a 32-year-old Caucasian female who presented with sudden-onset left-sided flank pain. She had recently been diagnosed with systemic lupus erythematosus (SLE) and had undergone a computed tomography (CT)-guided core needle biopsy of the left kidney 9 days earlier. The results were consistent with lupus nephritis class III or IV. Initial vitals were within normal limits. She appeared pale and her left flank was tender to palpation without discoloration or abdominal distention. Laboratory investigations showed a hemoglobin level of 7.1 g/dL. The CT scan of the abdomen and pelvis revealed a large hyperdense left perinephric collection consistent with perinephric hematoma with a moderate amount of retroperitoneal stranding most prominent on the left side extending across the midline to the right side. Contrast extravasation was suspected in the lower pole of the left kidney consistent with active bleeding site. Emergent renal angiography revealed a 2 × 1 cm intraparenchymal pseudoaneurysm in the lower pole of the left kidney along with a few small microaneurysms. Coil embolization of the pseudoaneurysm was successfully performed without any complications. In conclusion, SLE or lupus nephritis in this patient may be the predisposing factors for microaneurysm and RIP formations. RIP is an unusual complication after percutaneous kidney biopsy that carries a significant mortality rate if ruptured, causing retroperitoneal hemorrhage. Clinicians should be vigilant when encountering high-risk patients with persistent hematuria, flank pain, or abdominal pain within four weeks after a kidney biopsy.

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Section: Discussionmentioning

confidence: 99%

Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

Hansrivijit¹,

Gadhiya²,

Zelonis³

et al. 2021

Case Rep Nephrol Dial

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“…1 Complications may occur occasionally following an embolization procedure, with a risk of inadvertent parenchymal infarction. [5][6][7] Progressive advances in interventional radiographic techniques, such as enhanced imaging and the introduction of smaller devices, as well as more accurate embolic agents, have made superselective embolization of the renal artery an effective approach to diagnosis and treatment of renal hemorrhage. 1,2 In general, it requires a short hospital stay, yields a rapid recovery, is usually performed without the need for general anesthesia and with low rates of early and late complications, [4][5][6] limiting the classical surgical approach with nephrectomy to exceptional cases only.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Various embolic agents have been described in the literature for controlling bleeding in the renal region, but most series report embolization with coils as the preferred technique for renal artery embolization in several clinical scenarios. [6][7][8][9][10] This was the option chosen in the case reported here because it has some advantages compared to other methods. It is easy to manipulate, with controlled detachment into the target vessel only, promoting a minimal area of renal ischemia, since it does not close the distal microcirculation.…”

Section: Discussionmentioning

confidence: 99%

“…Its dilution in the iodinated contrast and use of zoom capabilities during the injection allows accurate tracking of the embolic agent, but should be used with caution; once released, it cannot be repositioned and prevents access to more distal segments of the vessel into which it was implanted. 2,6,7,9 Reported technical success rates vary between 71 and 100%. [4][5][6] The result is clearly dependent on the degree of difficulty of the procedure in selected cases.…”

Section: Discussionmentioning

confidence: 99%

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Superselective renal artery embolization for treatment of urological hemorrhage after partial nephrectomy in a solitary kidney

et al. 2020

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Embolization is a well-known and accepted form of treatment for bleeding caused by a multitude of renal procedures. We present a case of a 66-year-old woman who had a history of left nephrectomy for clear cell carcinoma seven years previously and now presented with a 6 cm tumor involving the solitary kidney. She underwent partial laparoscopic nephrectomy with removal of the tumor on the right kidney. In the immediate postoperative period she had important and persistent hematuria associated with tachycardia, hypotension, and lumbar pain. After showing signs of hemodynamic instability, she was taken to the catheter laboratory where selective angiography of the right kidney was performed. Superselective embolization with controlled release of fibrous microcoils was performed. The superselective renal embolization technique performed on an emergency basis to control hemorrhage after a urological procedure is effective and achieves lasting resolution of symptoms.

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“…Amongst the infective pseudoaneurysms, Candida albicans and Aspergillus species have been reported to be the predominant microorganisms, while Pseudomonas species were the leading cause of non-mycotic infective pseudoaneurysms[ 2 - 8 ]. Non-infective TRA pseudoaneurysms can result from injury to the arterial wall, faulty suture techniques[ 9 - 11 ] or following a biopsy[ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of transplant renal artery pseudoaneurysm using expandable hydrogel coils: A case report and review of literature

Marie¹,

Kumar²,

Hinchliffe³

et al. 2018

WJT

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Transplant renal artery (TRA) pseudoaneurysm can result in bleeding, infection, graft dysfunction and graft loss. We report the management of a renal transplant recipient who presented five months after renal transplantation with deterioration of renal function, who was found to have TRA pseudoaneurysm and TRA stenosis. Both were treated radiologically by using expandable hydrogel coils (EHC) in combination with stenting. Improvement in clinical, biochemical and radiological parameters were observed after the intervention. To our knowledge, this is the first report in the transplant literature on the use of EHC for the treatment of a TRA pseudoaneurysm.

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Renal pseudoaneurysm after core-needle biopsy of renal allograft successfully managed with superselective embolization

Cited by 4 publications

References 6 publications

Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

Superselective renal artery embolization for treatment of urological hemorrhage after partial nephrectomy in a solitary kidney

Treatment of transplant renal artery pseudoaneurysm using expandable hydrogel coils: A case report and review of literature

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