IS Case 111: Post-renal Biopsy Complication: perinephric hematoma and bleeding into the renal sinus

Lisa Siripun, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

A 32-year-old female with history of SLE, hypothyroid, lupus nephritis and autoimmune hepatitis underwent renal biopsy with subsequent renal hematoma and decrease hematocrit.

Diagnosis

Post-renal biopsy complication: perinephric hematoma and bleeding into the renal sinus.

Discussion

Percutaneous renal biopsy plays an important role in the diagnostic work-up of renal disease. Several studies have documented a 6–7% incidence of post-biopsy complications including gross hematuria, perirenal hematoma, acute renal obstruction, arteriovenous fistula (AVF), renal abscesses and septicemia.

Bleeding is the main complication of renal biopsy. Post-biopsy scanning has shown that the vast majority of patients develop a perirenal hematoma, which is usually asymptomatic. Significant bleeding occurs in about 1 in 1000 cases.

Another relatively common complication is AVF as a result of simultaneous damage of the walls of adjacent arteries and veins, this is a relatively common complication of renal biopsy. AVF could be proved to occur in 15–18% of patients by arteriography. In most cases these AVF are clinically occult, and most of the remaining fistulas disappear spontaneously (more than 95% resolve within 2 years). However, AVF may occur in other patients together with persistent and severe bleeding, uncontrollable hypertension, deterioration of renal function, or heart failure.

Arteriography is the gold standard for the diagnosis of vascular complications. Other non-invasive procedures are color-coded Doppler sonography and dynamic contrast CT scan. The main treatment is superselective embolization with coaxial catheter technique which is a safe and efficient method for the treatment of patients with severe renal hemorrhage. Early angiography and embolization of injured renal artery branches are essential: accumulation of intrarenal hematoma in a neglected injury creates an anatomic deformation that alters the course of renal artery branches and thus prevents selective catheterization and embolization. In case of massive and unremitting renal hemorrhage, angiographic ablation is far more desirable than nephrectomy. The embolic agents that are frequently used include gelfoam, steel coils or detachable balloon. Complication of embolization includes renal infarction, postembolization hypertension, renal failure, colonic infarction, renal abscess and pulmonary embolus.

References

  1. Herrero JC, Morales E, Carreño A, et al. Severe haemorrhage and retroperitoneal haematoma secondary to renal biopsy. Nephrol Dial Transplant. 2001 May;16(5):1078-9. [PMID: 11328926]
  2. Dondelinger RF, Rossi P, Kurdziel J, Wallace S (eds). Interventional Radiology. Thieme, 1990; 314-315, 391.

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