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Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: a single tertiary center experience

  • Urology - Original Paper
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Abstract

Purpose

To assess clinical presentation and outcomes of different treatment strategies in cases of spontaneous renal hemorrhage (SRH).

Methods

A retrospective analysis of patients with SRH between 2000 and 2018 was performed. Patients’ demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of the success of conservative treatment. The secondary outcome was to assess the long-term renal function outcome comparing serum creatinine, e GFF, and CT-assessed renal volume at last follow-up with baseline values.

Results

The study included 42 (23 males and 19 women) patients with mean ± SD age was 48.1 ± 17.8 years. Conservative management was successful in 19 (46%) patients. Trans-arterial embolization (TAE) was performed in 13 patients (30%) to control active bleeding. Ten patients (25%) required surgical exploration and nephrectomy. Lower serum creatinine (P = 0.003), higher prothrombin concentration (P = 0.04), lower hematoma size (P = 0.02), and non-AML lesions (P = 0.03) were independent predictors of conservative management success. Unlike the TAE-treated group, serum creatinine increased significantly (P = 0.04) with a significant decrease in e-GFR (P = 0.02) and renal volume (P < 0.001) of affected kidneys at last follow-up after conservative treatment.

Conclusion

Although SRH is a life-threatening condition, conservative treatment is successful in a certain subset of patients. However, it is associated with significant deterioration of the affected kidney function as well as renal volume.

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Funding

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Authors and Affiliations

  1. Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    M. A. Elbaset, Mohamad H. Zahran, Ramy EL-Baz & Yasser Osman

  2. Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Mohamed Badawy

Authors
  1. M. A. Elbaset
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  2. Mohamad H. Zahran
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  3. Ramy EL-Baz
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  4. Mohamed Badawy
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  5. Yasser Osman
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Contributions

Elbaset MA: patients’ follow-up and statistical analysis and manuscript writing; Mohamad H Zahran: manuscript editing; Ramy  EL-Baz: data collection; Mohamed Badawy: radiology data supervision; Yasser Osman: study supervision and manuscript revision.

Corresponding author

Correspondence to M. A. Elbaset.

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Human and animal rights

All procedures in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Elbaset, M.A., Zahran, M.H., EL-Baz, R. et al. Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: a single tertiary center experience. Int Urol Nephrol 52, 423–429 (2020). https://doi.org/10.1007/s11255-019-02333-9

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  • DOI: https://doi.org/10.1007/s11255-019-02333-9

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