What Is Renal Hemorrhage?
Renal hemorrhage or hematoma is the term used to describe intraparenchymal renal hemorrhage in a patient without trauma or anticoagulation with an unknown origin. Although there have been a few cases linked to infection, uncontrolled hypertension, ruptured hemorrhagic cysts, or erosion from large renal stones, renal hemorrhage is typically linked to vasculitides (polyarteritis nodosa), vascular, renal tumors (angiomyolipoma or renal cell carcinoma), or vascular malformations.
Patients with renal hemorrhage commonly feel Lenk's trio of soreness, flank discomfort, and blood loss symptoms, depending on the volume of blood lost, such as tachycardia, disorientation, and hypotension. Nonetheless, renal bleeding is frequently found by chance on ultrasonography or a contrast-enhanced abdomen CT since it might mimic other acute abdominal diseases. The most frequent test results are hematuria (blood in urine) and anemia (deficiency of hemoglobin in blood).
What Is Nontraumatic Renal Hemorrhage?
A medical disease known as nontraumatic renal hemorrhage is characterized by bleeding in or near the kidney that has no apparent traumatic injury or etiology. This condition may be caused by a range of underlying factors, such as vascular abnormalities, tumors, infections, or certain medical treatments. Hematuria, hypotension, and flank discomfort are some nontraumatic renal bleeding symptoms that may be present. Diagnosis is typically made using imaging tests, such as CT scans, MRIs, or ultrasounds.Treatment for nontraumatic renal hemorrhage depends on the severity of the condition and underlying cause and may involve monitoring, medication, or surgical intervention in severe cases.
What Are the Reasons Behind Non Traumatic Renal Hemorrhage?
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Nontraumatic renal hemorrhage is primarily caused by bleeding from pre-existing renal tumors, whether benign (such as angiomyolipoma, which is more likely to bleed when it exceeds five centimeters in diameter) or malignant (such as renal cell carcinoma).
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Acute renal hemorrhage leading to acute flank pain, with or without hematuria, can also be caused by arteriovenous malformations and renal artery aneurysms. Patients taking anticoagulants, particularly warfarin, are at an increased risk for renal hemorrhage due to underlying renal pathology, even if it is minor.
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Renal hemorrhage is often associated with hidden vascular, renal tumors (such as angiomyolipoma or renal cell carcinoma), vasculitides (such as polyarteritis nodosa), or vascular malformations. Idiopathic refers to conditions that have no known etiology or causes, whereas other reasons include infection, uncontrolled hypertension, burst hemorrhagic cysts, and erosion from large renal stones.
How Is Nontraumatic Renal Hemorrhage Diagnosed?
Nontraumatic renal hemorrhage is typically diagnosed through a combination of clinical evaluation and imaging tests.
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Laboratory Tests - The clinical evaluation may involve a physical exam to assess for symptoms such as flank pain, blood in the urine, and low blood pressure. Laboratory tests may also be performed to assess for anemia and hematuria.
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Imaging Tests - Imaging tests are important in the diagnosis of nontraumatic renal hemorrhage. Ultrasound, CT scan, and MRI are all commonly used to visualize the kidneys and surrounding structures and detect any areas of bleeding. The recommended imaging method for a conclusive diagnosis and pre-procedural planning is frequently a contrast-enhanced CT scan.
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Kidney Biopsy - In some cases, a kidney biopsy may also be performed to help determine the cause of the hemorrhage. The choice of diagnostic tests may vary depending on the patient's clinical presentation and the suspected underlying cause of the renal hemorrhage.
How Is Nontraumatic Renal Hemorrhage Treated?
The severity of the illness and underlying etiology determine the course of treatment for nontraumatic renal bleeding. While some hemorrhages may resolve independently, more severe cases require intervention to prevent complications.
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Renal Tumor or Vascular Malformation - Renal tumors or vascular malformations are among the underlying conditions that can cause nontraumatic renal hemorrhage. Renal tumors may be benign, such as angiomyolipoma or malignant, such as renal cell carcinoma. Vascular malformations, such as arteriovenous malformations and renal artery aneurysms, can also be sources of acute renal hemorrhage.Treatment options vary depending on the cause of the hemorrhage. In cases where the bleeding is due to an underlying condition such as a renal tumor or vascular malformation, surgery may be necessary to remove the affected tissue, or minimally invasive techniques like embolization or ablation may be used to stop the bleeding.
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Underlying Medical Conditions - If the bleeding is due to an underlying medical condition such as uncontrolled hypertension, the focus may be on managing the underlying condition to prevent further bleeding. Patients taking anticoagulants may need to have their medication adjusted or discontinued to prevent further bleeding. Patients with significant bleeding and low blood pressure may require supportive measures like blood transfusions to stabilize their condition.
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Nephrectomy- Nephrectomy, which is the surgical removal of a kidney, may be considered a treatment option for nontraumatic renal hemorrhage in cases where the bleeding is severe and life-threatening and other treatments have failed or are not feasible. However, it is generally recommended in certain circumstances. For example, if the bleeding is due to a large renal tumor that cannot be managed with other interventions or if there is extensive damage to the kidney and surrounding tissue that cannot be repaired, a nephrectomy may be necessary. However, this procedure can have significant risks and potential complications, including bleeding, infection, and the need for long-term dialysis. The decision to perform a nephrectomy depend on the individual patient's situation and will be made in consultation with their healthcare provider. Other less invasive treatments, such as embolization or ablation, are often preferred and may be effective in managing nontraumatic renal hemorrhage.
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Selective Arterial Embolization - Nontraumatic renal hemorrhage may be treated with selective arterial embolization. Selective arterial embolization is a less invasive treatment. A catheter is inserted through the groin artery and directed to the renal artery supplying the afflicted kidney. Small particles are injected into the artery once the catheter is in place to obstruct blood flow to the bleeding spot, forcing it to clot and halt the bleeding. Selective arterial embolization is often preferred over more invasive surgical procedures, such as nephrectomy, as it is associated with a lower risk of complications and a shorter recovery time. It is typically successful at reducing bleeding as well, and stable patients with nontraumatic renal hemorrhage may receive it as their first course of treatment. However, it is important to note that not all cases of renal hemorrhage are amenable to embolization, and the decision to perform the procedure will depend on the patient's specific situation and underlying condition.
Conclusion:
Various patients with renal or perirenal hemorrhage are generally diagnosed with an underlying cause. However, nontraumatic renal hemorrhage is rarely reported. It is essential to manage these patients carefully, as the diagnosis is confirmed only after any correctable surgical cause has been ruled out. Although an underlying cause is usually associated with most cases of renal and perirenal hemorrhages, there are rare instances when nontraumatic spontaneous renal laceration occurs with minimal symptoms.
