Oliguria due to extensive subcapsular hematoma in renal graft: does surgical intervention ensure better outcomes?

Subcapsular renal transplant hematoma mimicking acute tubular necrosis

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. However, it is associated with serious potential complications, one of which is the subcapsular renal transplant hematoma. Ultrasound is the major imaging tools in the evaluation of early graft complications. We discuss the case of a patient who underwent a living-donor kidney transplantation, complicated of acute kidney injury documented on serial blood tests with an elevation of creatinine levels and oliguria. Ultrasonography showed the presence of a subcapsular renal hematoma, associated with the same spectral characterizations of an acute tubular necrosis with a high resistive index on Color Doppler Ultrasonography Study of renal arteries. The patient underwent an emergent surgical evacuation of the subcapsular renal hematoma. A repeat ultrasonography showed the complete resolution of the subcapsular renal hematoma with normal resistive index. During the following days, diuresis was back to normal and serial blood tests showed normal levels of creatinine. This case report highlights the importance of Ultrasonography in detecting subcapsular hematomas that could be a reversible cause of acute kidney injury and acute tubular necrosis in the setting of renal transplant.

Acute Renal Failure in Kidney Transplantation Due to Subcapsular Hematoma After a Renal Allograft Biopsy: Report of Two Cases and Literature Review

The compression of the renal parenchyma due to a subcapsular hematoma, also known as the "Page kidney," is a potentially serious but treatable complication of renal biopsy. Hypertension is very common and, in some cases, renal failure may be present. In kidney transplantation, it is a not well-described entity. Rapid intervention is essential to avoid irreversible damage of the graft and preserve its function. We report 2 cases of acute renal failure due to Page kidney in patients with renal transplant after a percutaneous biopsy with successful recovery after surgical treatment. In addition, we conducted a literature review in order to describe the clinical characteristics of this infrequent complication in patients with a history of renal transplant.