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Renal Hematoma

Hematoma of Kidney


Presentation

  • Renal hematoma may present with signs and symptoms, which may mimic the clinical presentation of abruptio placentae or rupture uterus.[ncbi.nlm.nih.gov]
  • Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.[ncbi.nlm.nih.gov]
  • Two patients presented within 24 h of URSL, and one patient presented on day 10. One patient was treated conservatively for 3 weeks and recovered with bed rest, antibiotics, hemostasis, and analgesia with no intervention or drain.[ncbi.nlm.nih.gov]
  • Abstract A 73 year-old patient with history of arterial hypertension and regular treatment with antiplatelet agents who presented with an hypotensive episode after extracorporeal shock-wave lithotripsy (ESWL) was diagnosed of right renal hematoma.[ncbi.nlm.nih.gov]
  • In this report we present a case of a nontraumatic retroperitoneal hemorrhage secondary to spontaneous subcapsular renal hematoma. A 54-year-old patient who was under warfarin therapy, developed subcapsular right renal hematoma.[ncbi.nlm.nih.gov]
Intravenous Administration
  • To force the stone to move out from the renal pelvis, intravenous administration of 20 mg furosemide (Luo Fu Shang Zhu She Ye, Luo Fu Shang Guo Yao Inc., Guangzhou, China) was applied, and a lower hip position and a high flushing pressure of the irrigation[ncbi.nlm.nih.gov]
Aspiration
  • The infected hematoma was successfully drained by sonar-guided fine-needle aspiration. All reported cases of renal hematomas complicating anticoagulant therapy are reviewed.[ncbi.nlm.nih.gov]
  • We suspected infective subcapsular renal hematoma, so percutaneous needle aspiration and drainage were performed. Intravenous sulbactam-ampicillin was started immediately.[ncbi.nlm.nih.gov]
Abdominal Pain
  • A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis.[ncbi.nlm.nih.gov]
  • Abstract An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10 days earlier, her oral intake gradually decreased with no other specific symptoms, such as abdominal pain, nausea, vomiting, headache, or low back pain.[ncbi.nlm.nih.gov]
  • Livedo reticularis, nodules, mononeuritis multiplex, abdominal pain, and testicular involvement are well-described features.[indianjnephrol.org]
  • We showed a patient aged 63 years hospitalized due to languor, febrility, abdominal pain accompanied by nausea and vomiting.[degruyter.com]
Hypertension
  • A history of hypertension and higher BMI are important predisposing factors to perirenal hematoma.[ncbi.nlm.nih.gov]
  • Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative.[ncbi.nlm.nih.gov]
  • Abstract A 73 year-old patient with history of arterial hypertension and regular treatment with antiplatelet agents who presented with an hypotensive episode after extracorporeal shock-wave lithotripsy (ESWL) was diagnosed of right renal hematoma.[ncbi.nlm.nih.gov]
  • If hypertension persists, the renal function deteriorates PAGE KIDNEY: SUBCAPSULAR HAEMATOMA AND ARTERIAL HYPERTENSION. .. Figura 2.[redalyc.org]
  • The rates of diabetes, stopped anticoagulant/antiplatelet medications and arterial hypertension were not different between the two groups (p 0.2). The skin-kidney distance was virtually the same in both groups (p 0.5).[ncbi.nlm.nih.gov]
Chest Pain
  • Eighteen months earlier, she had chest pain and underwent transfemoral cardiac angiogram at a different institute. Since then, she had been taking aspirin 100 mg under the diagnosis of angina.[jkns.or.kr]
Back Pain
  • Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment.[ncbi.nlm.nih.gov]
  • Abstract An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10 days earlier, her oral intake gradually decreased with no other specific symptoms, such as abdominal pain, nausea, vomiting, headache, or low back pain.[ncbi.nlm.nih.gov]
  • She developed a spontaneous right-sided perirenal hematoma, along with back pain, on the day of referral to the nephrology unit and a spontaneous left-sided perirenal hematoma ten days later.[rrtjournal.biomedcentral.com]
  • […] retroperitoneal fibrosis, retroperitoneal sarcomas, or cancers that spread to the lymph nodes near the ureters Kidney stone disease Radiation to the belly area Trauma Emergency symptoms may include: Abdominal pain and swelling Severe flank pain and back[medlineplus.gov]
  • Symptoms of hematomas depend upon their location and whether adjacent structures are affected by the inflammation and swelling associated with the bleeding and may include headache, confusion, seizures (subdural hematoma), back pain, loss of bladder or[medicinenet.com]
Neglect
  • Thus, urological surgeons often neglect or are unaware of subcapsular renal hematoma (SRH) as a rare complication following URSL. Although a SRH after undergoing URSL is uncommon, the occurrence may be fatal.[ncbi.nlm.nih.gov]
Flank Pain
  • The most common symptoms of renal hematoma are severe flank pain and hematuria. A history of hypertension and higher BMI are important predisposing factors to perirenal hematoma.[ncbi.nlm.nih.gov]
  • She complained of right flank pain and fever and the findings following abdominal echography, computerized tomography (CT) scan and renal angiography agreed with a diagnosis of subcapsular renal hematoma without renal tumor.[ncbi.nlm.nih.gov]
  • I also have an ovarian cyst which they are removing this week to see if my flank pain could be referred pain from that.[csn.cancer.org]
  • Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.[ncbi.nlm.nih.gov]
  • She complained of right flank pain… (More)[semanticscholar.org]

Workup

  • Workup disclosed a large perirenal and retroperitoneal hematoma, this patient was treated with antibiotics, fever eventually resolved spontaneously.[bioaccent.org]

Treatment

  • All of them received conservative and supportive treatment without surgical exploration. Ten (50%) patients had a history of hypertension. Renal hematoma developed in 11 patients at the second or third SWL treatment.[ncbi.nlm.nih.gov]
  • Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5%.[ncbi.nlm.nih.gov]
  • Lithotripsy treatments were outpatient procedures without anaesthesia.[ncbi.nlm.nih.gov]
  • Relative to baseline, there was reduction in the diameter of hematoma evaluated by the enhanced CT scan after treatment (from 11.7 3.1 to 2.8 1.0 cm).[ncbi.nlm.nih.gov]
  • The treatment of post-URSL renal subcapsular hematomas needs to be customized for each patient.[ncbi.nlm.nih.gov]

Prognosis

  • Corticosteroids plus pulse cyclophosphamide and plasma exchanges versus corticosteroids plus pulse cyclophosphamide alone in the treatment of polyarteritis nodosa and Churg–Strauss syndrome patients with factors predicting poor prognosis.[nature.com]

Etiology

  • We conclude that conservative management is the first choice for subcapsular renal hematoma without a definite etiology, especially in an elderly patient.[ncbi.nlm.nih.gov]
  • In the absence of an apparent etiology, patients with spontaneous renal bleeding and a normal contralateral kidney should undergo radical nephrectomy because of the extremely high incidence of small undetectable occult tumors, often less than 2 cm. in[ncbi.nlm.nih.gov]
  • In the absence of an apparent etiology, patients with spontaneous renal bleeding and a normal contralateral kidney should undergo radical nephrectomy because of the extremely high incidence of small undetectable occult tumors, often less than 2cm. in[auajournals.org]
  • Zhang JQ, Fielding JR, Zou KH. 2002 Etiology of spontaneous perirenal hemorrhage: A meta-analysis. J Urol.167:1593-1596.[theisn.org]
  • Previously, renal tumor was thought to be the underlying cause when there was no obvious etiology and radical nephrectomy was advised. We report our experience of a case who developed SPH in association with urinary tract infection.[openurologyandnephrologyjournal.com]

Epidemiology

  • Epidemiology of renal trauma: In blunt abdominal trauma, up to 40% present with renal injury. In urban areas, 80% of renal injuries occur in the context of polytrauma. In ski resorts, 2/3 of renal injuries are due to skiing accidents.[urology-textbook.com]
  • Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany. Rheumatology (Oxford) 39, 1396–1402 (2000). 4.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Unlike true capillary hemangiomas that regress in childhood and are a cosmetic nuisance, the lesions in KMS are distinctive vascular tumors, that include tufted angiomas and kaposiform hemangioendotheliomas. 2 The pathophysiology is believed to be consumption[nature.com]
  • Uremic Bleeding: Pathophysiology, Diagnosis, and Management. Hospital Physician 2001 May; 76 45-50. Mannucci, M. Desmopressin (DDAVP) in the Treatment of Bleeding Disorders: The First 20 Years. Blood 1997 October 90(7): 2515-2521.[emdocs.net]

Prevention

  • Prevention of this complication is associated with the surgeon's awareness. When the patients have risk factors, this complication must be taken into consideration by urologists.[mjdrdypu.org]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • It can cause hemorrhagic shock when the active bleeding fails to be prevented.[ncbi.nlm.nih.gov]

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