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[Spontaneous kidney parenchymal rupture--etiology, symptoms, diagnosis and therapy]
Abstract:
Spontaneous rupture of the renal parenchyma with perirenal hematoma occurs rarely. A review was made of 85 cases published in the literature, including 2 of our own. Tumors were the most common cause followed by vascular diseases of the kidney. The most common symptoms were an acute onset of flank or abdominal pain (65%), microscopic or macroscopic hematuria (43%) and signs of hemorrhagic shock (33%). In all cases a tender flank and/or mass were palpable. Urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful and life-threatening.
Insights
Spontaneous rupture of the kidney (renal parenchyma) with bleeding around the kidney (perirenal hematoma) is rare. Prompt surgical removal of the kidney (nephrectomy) is crucial for survival.
Area of Science:
- Urology
- Nephrology
- Radiology
Background:
- Spontaneous rupture of the renal parenchyma with perirenal hematoma is a rare clinical emergency.
- This condition necessitates a thorough understanding of its causes, presentation, and management.
Observation:
- A literature review of 85 cases, including two from the authors' institution, was conducted.
- Tumors and renal vascular diseases were identified as the leading etiologies.
- Common symptoms include acute flank/abdominal pain (65%), hematuria (43%), and signs of hemorrhagic shock (33%).
Findings:
- Physical examination frequently reveals a tender flank and/or palpable mass.
- Urography demonstrates findings such as a renal mass, distorted collecting system, or kidney non-visualization.
- Conservative management is associated with uniformly unsuccessful outcomes and is life-threatening.
Implications:
- Prompt nephrectomy is indicated when feasible to ensure patient survival.
- Early diagnosis and surgical intervention are critical for managing spontaneous renal rupture.
- This review highlights the importance of timely surgical management over conservative approaches.