Asymptomatic Large Extracapsular Renal Pseudoaneurysm Following Kidney Transplant Biopsy

Rivera, Maite; Villacorta, Javier; Jiménez-Álvaro, Sara; Quereda, C.

doi:10.1053/j.ajkd.2010.07.020

Cited by 19 publications

(16 citation statements)

References 15 publications

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“…and in transplanted kidneys, particularly in pediatric patients, because of the relatively superficial location of the biopsied organ. Renal AVFs may be associated with pseudoaneurysms, which are sometimes quite large [3].…”

Section: Discussionmentioning

confidence: 99%

Renal arteriovenous fistula simulating hydronephrosis: A case report

Lusenti

Fiorini²,

Barozzi

2011

Journal of Ultrasound

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KEYWORDSRenal arteriovenous malformations; Renal arteriovenous fistula; Pseudoaneurysm; Hydronephrosis.Abstract Introduction: Acquired renal arteriovenous fistulas (AVFs) include those that occur as a complication of renal biopsy. Case report: The authors report the case of a woman with recent-onset grade I hypertension, who was referred to our staff for sonographic studies of the kidneys and urinary tract. Laboratory data revealed microhematuria and proteinuria <0.5 g/24 h, and renal function was borderline (MDRD GFR 58 mL/min). Renal sonography of the left kidney revealed an anechoic, arboriform area at the level of the pelvis, which was suggestive of hydronephrosis. The color Doppler examination showed turbulent flow within the anechoic area, with high-velocity arterial flow and arterialization of the venous waveform at spectral analysis. Selective renal angiography later confirmed the presence of a middle renal AVF with pseudoaneurysm, which had been provoked by a renal biopsy performed over 10 years earlier in another center. Since the patient was currently in good health, the prescribed management consisted solely of close clinical and US follow-up. Discussion: AV fistulas are among the most commonly diagnosed renovascular malformations. The case reported here underlines the importance of using color Doppler ultrasound when obstructive uropathy is suspected, especially in patients who have undergone renal biopsy. SommarioIntroduzione: Tra le fistole arterovenose (FAV) acquisite vi sono quelle che si formano quale complicanza dell'esecuzione di una biopsia renale. Caso clinico: Gli autori riportano il caso di una paziente giunta in ambulatorio di ecografia nefrologica per l'esecuzione di un'ecografia dei reni e delle vie urinarie per un'ipertensione sistolica di I grado di recente insorgenza. Negli esami di laboratorio era presente microematuria con proteinuria <0.5 g/24 ore. La funzionalità renale risultava ai limiti inferiori della norma (FG 58 mL/min secondo la formula MDRD). L'esame ecografico evidenziava una formazione anecogena "arboriforme" centropielica a livello del rene sinistro suggestiva per * Corresponding author. Via Gadda 30, 42123 Reggio Emilia, Italy.E-mail address: emanue.lusenti4@hotmail.it (T. Lusenti).1971-3495/$ -see front matter ª 2011 Elsevier Srl. All rights reserved. doi:10.1016/j.jus.2011.10.006Available online at www.sciencedirect.com j ourna l home page: www.el sevier.com/loca te/ jusJournal of Ultrasound (2011) 14, 233e236 idronefrosi. Il color Doppler mostrava viceversa presenza di flusso turbolento all'interno dell'area anecogena stessa, con flusso arterioso elevato e arterializzazione del flusso venoso all'analisi spettrale. La successiva angiografia renale selettiva confermava il sospetto ecografico di FAV mediorenale sinistra con pseudoaneurisma, conseguente ad una biopsia renale effettuata più di 10 anni prima presso altro Centro. Essendo la paziente in pieno benessere veniva consigliato un più stretto follow-up clinico-ecografico. Discussione: Tra le malformazioni vas...

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Section: Discussionmentioning

confidence: 99%

Renal arteriovenous fistula simulating hydronephrosis: A case report

Lusenti

Fiorini²,

Barozzi

2011

Journal of Ultrasound

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“…The clinical manifestations of renal pseudoaneurysm vary from asymptomatic to nonspecific flank pain, hematuria, hypertension, and anemia [1] , [3] , [7] , [8] , [9] . Diagnosis is based on clinical suspicion and is critical to avoid the risk of rupture [1] , [2] , [3] , [10] . Although no consensus exists for the size at which a kidney pseudoaneurysm should be treated in the asymptomatic patient, the risk of rupture increases with the size of the pseudoaneurysm [1] , [10] .…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis is based on clinical suspicion and is critical to avoid the risk of rupture [1] , [2] , [3] , [10] . Although no consensus exists for the size at which a kidney pseudoaneurysm should be treated in the asymptomatic patient, the risk of rupture increases with the size of the pseudoaneurysm [1] , [10] . Selective angioembolization is first-line therapy for renal pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy

Yun

Kim

Park

et al. 2013

Kidney Research and Clinical Practice

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A 37-year-old man was referred to Division of Nephrology for a new renal cystic lesion that was found on ultrasonography. Four years prior to presentation, a percutaneous renal biopsy had been performed. Computed tomography scan showed a 4.4-cm-sized renal artery pseudoaneurysm in the left kidney. Selective renal angiography revealed a pseudoaneurysm in the left lower pole of the kidney. The renal pseudoaneurysm was successfully embolized with coil. Follow-up Doppler ultrasonography showed no internal blood flow into the aneurysmal sac. His renal function remained stable after coil embolization.

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“…The site of embolization should be close to the pseudoaneurysm neck to minimize renal parenchymal ischemia. 11,12 Various embolic agents have been used, namely, platinum microcoils, cyanoacrylate glue, PVA particles, and gel foam. Percutaneous guided injection of thrombin or glue into sac is done when the pseudoaneurysm is inaccessible.…”

Section: Discussionmentioning

confidence: 99%

Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital

Gorsi

Soundararajan

Jugpal

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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Objectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morphology, imaging features, and treatment adopted. To the best of our knowledge, this is the largest such study done in India. Methods This was a retrospective study of patients treated for renal pseudoaneurysms between 2014 and 2019. We reviewed their clinical data, treatment modalities used, and clinical outcomes. We also assessed computed tomography angiography (CTA) and conventional angiography images. Results A total of 79 patients (54 males and 25 females) were included in the study. The mean age was 39.5 years (range 15–83 years). The most common cause was renal biopsy, followed by surgery. Of these, three patients (3.9%) had more than one lesion and 57% of pseudoaneurysms were seen in lower polar arteries. Active contrast extravasation was seen in 15.2% (n = 12) of the patients and 21.5% (n = 17) showed lobulations in CT and digital substraction angiography. The mean size of the pseudoaneurysms was 1.17 cm (SD 0.7); 22.8% of pseudoaneurysms were wide necked. The embolization was approached by endovascular (89.9%), percutaneous (10.1%), or both (1.3%) routes. Embolization was performed using microcoils (78.5%), gel foam (12.7%), N-butyl cyanoacrylate glue (8.9%), polyvinyl alcohol (8.9%), and thrombin (5.1%) either as a single agent or in combination. The technical success was achieved in all cases after the first procedure. Pseudoaneurysms with a wide neck (p = 0.03) and lobulations (p = 0.002) were associated with active contrast extravasation. Episodes of rebleeding were seen at a younger age (p-value = 0.02). Conclusion Minimally invasive methods remain the cornerstone in the management of renal pseudoaneurysms with high success rates. The morphology of pseudoaneurysms can help predict the risk of active bleeding and decide the type of intervention. Direct percutaneous injection into the aneurysm sac is an alternate technique and should be considered when an endovascular approach is challenging.

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Asymptomatic Large Extracapsular Renal Pseudoaneurysm Following Kidney Transplant Biopsy

Cited by 19 publications

References 15 publications

Renal arteriovenous fistula simulating hydronephrosis: A case report

Renal arteriovenous fistula simulating hydronephrosis: A case report

Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy

Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital

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