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Bermudez-Gonzalez JL, Rodríguez-Encinas B, Beverido-Florido ÁM, Gabutti-Thomas JA. Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient. Case Rep Radiol 2023; 2023:5570992. [PMID: 37727639 PMCID: PMC10506877 DOI: 10.1155/2023/5570992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Subcapsular renal hematomas may appear spontaneously in patients in chronic hemodialysis, though other causes as neoplasms, vasculitis, and infections should be excluded. Patients may present with abdominal pain and hemorrhagic shock; hence, early diagnosis is vital. Nephrectomy or renal artery embolization are suitable treatment options.
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Affiliation(s)
- Jorge Luis Bermudez-Gonzalez
- Graduate Studies Division, Medicine School, National Autonomous University of Mexico, Mexico City, Mexico
- Education Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Bethsabel Rodríguez-Encinas
- Graduate Studies Division, Medicine School, National Autonomous University of Mexico, Mexico City, Mexico
- Education Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Ángel Miguel Beverido-Florido
- Graduate Studies Division, Medicine School, National Autonomous University of Mexico, Mexico City, Mexico
- Education Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Jesús Alejandro Gabutti-Thomas
- Interventional Radiology Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
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Lee TW, Bae W, Choi J, Bae E, Jang HN, Chang SH, Park DJ. Page kidney following spontaneous subcapsular hematoma immediately after kidney transplantation: a case report. BMC Nephrol 2022; 23:239. [PMID: 35799146 PMCID: PMC9260983 DOI: 10.1186/s12882-022-02855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Page kidney (PK) is the occurrence of kidney hypoperfusion and ischemia due to pressure on the kidney by a subcapsular hematoma (SH), a mass, or fluid collection. SH after renal transplantation may result in kidney ischemia and graft loss. CASE PRESENTATION We present a rare case of early spontaneous SH in an allograft kidney that led to a decrease in renal function. A 56-year-old male patient underwent deceased donor kidney transplantation. After declamping, appropriate renal perfusion and immediate diuresis were observed, with no evidence of SH. However, his urinary output abruptly decreased 6 h postoperatively. Abdominal ultrasonography showed 28 mm deep SH on transplant and the resistive index (RI) increased to 0.98-1 and diastolic flow reversal was observed. Surgical interventions were performed 2 days after transplantation, following a further decrease in urinary output. Serum creatinine decreased to 2.2 mg/dL, urinary output increased to an average of 200 cc per hour and the RI value was decreased to 0.7 on POD 7. CONCLUSION In patients with abrupt decreased renal function after transplantation, SH should be suspected and the presence of PK should be determined using Doppler USG. In these cases, surgical intervention may avoid allograft dysfunction.
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Affiliation(s)
- Tae Won Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Wooram Bae
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jungyoon Choi
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Eunjin Bae
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea.,Department of Internal Medicine, Changwon Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, Republic of Korea.,Institute of Health Science, Gyeongsang National University, Jinju, South Korea
| | - Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Se-Ho Chang
- Department of Internal Medicine, Changwon Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, Republic of Korea.,Institute of Health Science, Gyeongsang National University, Jinju, South Korea.,Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Dong Jun Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea. .,Department of Internal Medicine, Changwon Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, 11 Samjungja-ro Sungsan-gu, Changwon, 51472, Republic of Korea. .,Institute of Health Science, Gyeongsang National University, Jinju, South Korea.
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