DOI: 10.36347/sjmcr.2017.v05i10.017

Pages: 661-665

Spontaneous renal hemorrhage (SRH) is characterized by the acute onset of non-traumatic subcapsular and/or perirenal hematoma formation. Idiopathic SRH is rare, as SRH is most commonly due renal neoplasms with renal angiomyolipoma (AML) followed by renal cell carcinoma (RCC). Idiopathic SRH is known as one of complication of hemodialysis (HD). It is often life-threatening due to hemorrhagic shock and requires prompt recognition and appropriate management. We herein report four cases of idiopathic SRH with HD. None of the patients had hematologic disease, congenital vascular anomalies or renal neoplasm, and none showed a bleeding tendency. Only one patient had taken anticoagulants. All of these patients were diagnosed with SRH by computed tomography (CT). Bleeding was stopped via transcatheter arterial embolization (TAE) with gelatin sponges in three and n-butyl-2-cyanoacrylate (NBCA) in one. No patients experienced rebleeding. Generally, the diagnosis of SRH is difficult due to its non-specific symptoms. Abdominal ultrasonography is not useful for identifying retroperitoneal hemorrhage. CT is useful for identifying not only perinephric hemorrhage with 100% sensitivity but also AML. Intravenously injected anticoagulants of HD seem to have a greater influence on the development of idiopathic SRH than oral anticoagulants. Indeed, HD with intravenous anticoagulants itself is a risk factor for idiopathic SRH. We can stop the bleeding of idiopathic SRH using gelatin sponges; TAE with gelatin sponges is therefore recommended to stop the bleeding of idiopathic SRH. This is because gelatin sponges can be used from the peripheral bleeding point to the main trunk of the renal artery. We do not recommend NBCA be used to stop bleeding of idiopathic SRH due to its technical difficulty and the ease with which NBCA can spread to other organs via the arteries.