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Bilateral renal hemorrhage due to polyarteritis nodosa wrongly attributed to blunt trauma

Nature Reviews Urology volume 6, pages 563–567 (2009)Cite this article

Abstract

Background. A 36-year-old, previously healthy man presented to an accident and emergency department with right-sided abdominal pain 7 days after he sustained a trauma to his right flank. He was using no medication other than over-the-counter analgesics since his injury.

Investigations. Complete blood count, serum creatinine measurement, liver function tests, hepatitis B and C screening, abdominal CT, renal angiography, surgical exploration and histology of kidney samples.

Diagnosis. Polyarteritis nodosa with Page kidney causing bilateral perirenal hematoma, severe hypertension and renal failure.

Management. The patient was severely anemic, and his bleeding was investigated. A 15 × 13 × 12 cm retroperitoneal hematoma was found in the region of the right kidney and the patient underwent unilateral right nephrectomy. 3 weeks after discharge the patient was readmitted with a left-sided perirenal hematoma. Steel-coil embolization of the kidney stopped the bleeding but the patient developed hypertension and renal failure, and antihypertensive agents and dialysis were started. Microaneurysms and vessel-wall necrosis were discovered on re-examination of the angiogram and histology, respectively, so immunosuppressive therapy was started, comprising intravenous methylprednisolone daily for 3 days and oral prednisolone and intravenous cyclophosphamide for 4 weeks. Page kidney, resulting from the bleeding into the solitary kidney, caused stretching of the renal artery and deterioration of renal function, which required hemodialysis treatment.

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Figure 1: Abdominal CT performed at the patient's first presentation.
Figure 2: Abdominal CT performed at the patient's second presentation.
Figure 3: Left renal angiogram.
Figure 4: Photomicrograph of a medium-sized artery.
Figure 5: Abdominal CT performed at the patient's third presentation.

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Author information

Authors and Affiliations

  1. Renal Unit, St Luke's Hospital, Bradford, UK

    Ihab El Madhoun

  2. Radiology Department, York University, York, UK

    Niall G. Warnock

  3. Renal Unit, York Hospital, York, UK

    Colin H. Jones

  4. Department of Histopathology, Hull Royal Infirmary, Hull, UK

    Anu Roy

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Correspondence to Ihab El Madhoun.

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Madhoun, I., Warnock, N., Roy, A. et al. Bilateral renal hemorrhage due to polyarteritis nodosa wrongly attributed to blunt trauma. Nat Rev Urol 6, 563–567 (2009). https://doi.org/10.1038/nrurol.2009.180

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