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Changing etiology and management patterns for spontaneous renal hemorrhage: a systematic review of contemporary series

  • Urology - Review
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Abstract

Objective

To conduct a systematic literature review on spontaneous renal hemorrhage (SRH) in a contemporary cohort describing patterns in etiology and treatment.

Methods

A systematic search of MEDLINE and CENTRAL databases was conducted to include articles, including case reports and case series on SRH published from 2000 to 2016. Full-text manuscripts were reviewed for clinical parameters which were collated and analyzed with univariate methods.

Results

Seventy-nine publications met inclusion criteria, reporting on 102 cases. Renal neoplasms (56.9%) and polyarteritis nodosa (PAN) (11.8%) remained as the most common overall and vascular causes of SRH, respectively. Angiomyolipoma (AML) was the most common causative renal neoplasm (74.1%), and patients were more likely to be female and present with macroscopic hematuria than those with vasculitis, while malignant neoplasms were more common in men. Proportions of SRH due to malignant neoplasms (specifically renal cell carcinoma, RCC) were reported less than PAN. Among this contemporary series, transarterial embolization (TAE) was most commonly used for acute SRH (42.2%).

Conclusions

Renal neoplasms remain as the most common cause of SRH, of which AML predominates, while PAN is currently the second most common etiology in acute SRH, replacing RCC. Minimally invasive approaches, such as TAE and conservative/medical management, were preferred to initial surgery.

Systematic review registration

PROSPERO registration number CRD42017069222.

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Acknowledgements

We would like to thank Jane Simon (hospital librarian) for assistance with the search strategy.

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Authors and Affiliations

  1. Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Thomas Ahn, Matthew J. Roberts, Anojan Navaratnam, Eric Chung & Simon Wood

  2. Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts, Eric Chung & Simon Wood

  3. Centre for Clinical Research, The University of Queensland, Brisbane, Australia

    Matthew J. Roberts

  4. AndroUrology Centre, Brisbane, Australia

    Eric Chung

  5. Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia

    Simon Wood

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  1. Thomas Ahn
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  2. Matthew J. Roberts
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  3. Anojan Navaratnam
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  4. Eric Chung
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  5. Simon Wood
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Corresponding author

Correspondence to Thomas Ahn.

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All authors declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ahn, T., Roberts, M.J., Navaratnam, A. et al. Changing etiology and management patterns for spontaneous renal hemorrhage: a systematic review of contemporary series. Int Urol Nephrol 49, 1897–1905 (2017). https://doi.org/10.1007/s11255-017-1694-8

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  • DOI: https://doi.org/10.1007/s11255-017-1694-8

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