Cargando…

Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy

BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thro...

Descripción completa

Detalles Bibliográficos
Autores principales: Kamarudin, Muhammad Imran, Nadarajan, Chandran, Daud, Mohamed Ashraf Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463818/
https://www.ncbi.nlm.nih.gov/pubmed/36085017
http://dx.doi.org/10.1186/s12882-022-02935-z
_version_ 1784787468821725184
author Kamarudin, Muhammad Imran
Nadarajan, Chandran
Daud, Mohamed Ashraf Mohamed
author_facet Kamarudin, Muhammad Imran
Nadarajan, Chandran
Daud, Mohamed Ashraf Mohamed
author_sort Kamarudin, Muhammad Imran
collection PubMed
description BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. CASE PRESENTATION: We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. CONCLUSION: Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.
format Online
Article
Text
id pubmed-9463818
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-94638182022-09-11 Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy Kamarudin, Muhammad Imran Nadarajan, Chandran Daud, Mohamed Ashraf Mohamed BMC Nephrol Case Report BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. CASE PRESENTATION: We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. CONCLUSION: Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case. BioMed Central 2022-09-09 /pmc/articles/PMC9463818/ /pubmed/36085017 http://dx.doi.org/10.1186/s12882-022-02935-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Kamarudin, Muhammad Imran
Nadarajan, Chandran
Daud, Mohamed Ashraf Mohamed
Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title_full Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title_fullStr Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title_full_unstemmed Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title_short Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
title_sort double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463818/
https://www.ncbi.nlm.nih.gov/pubmed/36085017
http://dx.doi.org/10.1186/s12882-022-02935-z
work_keys_str_mv AT kamarudinmuhammadimran doubletroublemanagementofperinephrichematomaandrenalveinthrombosispostpercutaneousrenalbiopsy
AT nadarajanchandran doubletroublemanagementofperinephrichematomaandrenalveinthrombosispostpercutaneousrenalbiopsy
AT daudmohamedashrafmohamed doubletroublemanagementofperinephrichematomaandrenalveinthrombosispostpercutaneousrenalbiopsy