Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

• Published in: BMC nephrology Vol. 22; no. 1; p. 217
• Main Authors: Zhao, Youlu, Jia, Xiaoyu, Tong, Xiaoqiang, Niu, Guochen, Wang, Rui, Liu, Lijun, Zhou, Fude
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09-06-2021; BioMed Central; BMC
• Subjects: Abdomen; Acute kidney injury; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Adult; Aneurysms; Antibodies; Anticoagulants; Arteriography; Biopsy; Bleeding; Blood; Blood platelets; Brain Diseases - etiology; Brain Diseases - therapy; Case Report; Case reports; Case studies; Combined Modality Therapy; Computed tomography; Contrast media; Creatinine; Diagnosis; Embolization; Embolization, Therapeutic; Encephalopathy; Extravasation; Female; Fever; Glucocorticoids - therapeutic use; Hematoma; Hematoma - diagnostic imaging; Hematoma - etiology; Hematoma - therapy; Hemodialysis; Hemoglobin; Hemorrhage; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Infections; Kidney diseases; Kidney Diseases - diagnostic imaging; Kidney Diseases - etiology; Kidney Diseases - therapy; Literature reviews; Lupus; Lupus Erythematosus, Systemic - complications; Methylprednisolone - therapeutic use; Nephrology; Patients; Perirenal hematoma; Proteins; Renal artery; Renal Replacement Therapy; Rupture, Spontaneous; Spontaneous kidney rupture; Systemic lupus erythematosus; Ulcers; Ultrasonic imaging; Urine; Veins & arteries; China; Perirenal hematoma; Systemic lupus erythematosus; Spontaneous kidney rupture; Acute kidney injury
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-021-02424-9

Spontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations.
We report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.
Spontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.