Spontaneous rupture of non-tumoral kidneys in patients with end stage renal failure: risks and management

OBJECTIVES: To determine the risks and treatment modalities of spontaneous subcapsular or perinephric bleeding in end stage renal patients. METHODS: 8 patients with end stage renal failure developed a spontaneous hemorrhage of one of their native kidneys and were referred to our institution. They were all men. Six of them presented an acquired renal cystic disease. Symptoms included sudden abdominal pain in 7 patients, vomiting in 2 and hematuria in 1. Symptoms were always associated with a hemoglobin decrease. Four patients were receiving oral anticoagulants for various reasons and one had thrombopenia. Bleeding was confirmed by computerized tomography and nephrectomy undertaken in all cases. RESULTS: 3 patients died in the immediate post-operative period. Histologic findings confirmed bleeding and did not find any other abnormality than those related to renal insufficiency (cysts and atrophy). CONCLUSION: Renal rupture should be considered in case of unexplained distress or sudden fall of the hemoglobin especially when patients are on anticoagulants. Surgery is our preferred treatment because of the frequency of unrevealed tumours and the potential mortality of massive hematomas.