Iatrogenic renal vascular injury

Bilateral arteriovenous fistulas secondary to percutaneous needle biopsy of each kidney dcrcloped in a patient with malignant hypertension and chronic renal failure. The fistulas with aneurysmal formation and hematuria were of such magnitude that bilateral nephrectomy was required fin control. The patient is now normotensive and is maintained on hemodialysis The advisability of renal needle biopsy in uncontrolled hypertension is questioned. Cases o] intrarenal arteriovenous fistulas resulting from percutaneous needle biopsy of the kidney are being reported with increasing frequency. The exact incidence of fistula formation after kidney biopsy, is unknoun but several series based on arteriographic studies show an incidence as high as IN per cent. A1though many of these fistulas disappear spontaneonsly, approximately 4 per cent persist. A review of the literature failed to reveal the incidence of aneurysmal formation. Our case was complicated by formation of bilateral renal arteriovenous fistulas secondary to repeat bilateral percutaneous needle biopsy and right open renal biopsy. Subsequent gross hematuria from the ureteral orifice also resulted which was proved by cystoscopy and required replacement with sev eral units of blood. The likelihood of rupture led to bilateral nephrectomy.