Arteriovenous fistula-related renal bleeding 5 days after percutaneous renal biopsy

Abstract

A 32-year-old Japanese woman was admitted to our hospital for evaluation of microscopic hematuria with a positive family history. Percutaneous renal biopsy was performed under real-time ultrasound guidance using a 16-gauge automated needle and three specimens were obtained. She had no risk factors for hemorrhage. However, macroscopic hematuria developed from 5 days after biopsy and persisted for 4 days. Her Hb decreased markedly from 15.0 to 8.1 g/dL. Enhanced computed tomography revealed urinary tract hematoma, while the early arterial phase showed inflow of contrast medium into the left renal vein from a pseudoaneurysm on a branch left renal artery. Renal transcatheter arterial embolization was performed using platinum microcoils and the arteriovenous fistula was occluded. The patient did not require blood transfusion. Severe renal bleeding that causes urinary tract hematoma usually occurs within 24 h after renal biopsy, but the possibility of late-onset renal bleeding should be kept in mind.

Post traumatic internal iliac arteriovenous fistula presenting with persistent gross hematuria

“…While there are reports of iatrogenic AVFs post renal biopsy diagnosed by persistent gross hematuria, to our knowledge this is the first reported case of a traumatic pelvic AVF presenting with gross hematuria. 2 An estimated 70% of traumatic AVF are diagnosed in a delayed fashion as in this instance. 3 Diagnosis of a pelvic AVF may necessitate a high suspicion of AVF.…”

Acute Brachial Arterial Embolic Occlusion Following Anticoagulant Discontinuation in a Renal Biopsy of a Nephrotic Syndrome Patient

“…Several recommendations for the periprocedural management of anticoagulants have been published; however, in clinical practice, anticoagulants are empirically resumed after renal biopsies, depending on the evaluated hemorrhagic and thrombotic risks. According to the previous version of the renal biopsy guideline published by Japanese Society of Nephrology in 2004, anticoagulants should be discontinued for one or two weeks after renal biopsies because of delayed hemorrhagic complications (5,6). However, in the new version of the guideline, published in 2020, anticoagulants should be resumed one or two days after renal biopsies or when medical tests reveal no evidence of aggravated renal bleeding (7).…”