Pseudoaneurysm with severe haematuria in renal allograft after renal biopsy treated by percutaneous embolization

(Section Editor: G. H. Neild)

Ajay K. Sharma1, Sivaprasad Sunil1, Peter Rowlands2 and Ali Bakran1,

1 Sir Peter Medawar Transplant Unit and 2 Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK

Keywords: embolization; renal pseudoaneurysm; transplant biopsy

A 61-year-old lady received a cadaveric renal transplant in March 1996. On the seventh post-operative day, a renal allograft biopsy was performed under ultrasound guidance. The patient developed severe haematuria requiring a 2-U blood transfusion. Duplex scanning demonstrated a pseudoaneurysm (2.5x2.9 cm) at the upper pole of the kidney (Figure 1Go). Arteriography demonstrated two pseudoaneurysms arising from a cortical artery (Figure 2Go). These pseudoaneurysms were embolized selectively with four metal coils (Figure 3Go). There was no further haematuria. The renal biopsy showed evidence of acute tubular necrosis. She underwent two further uneventful transplant biopsies before attaining good renal function.



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Fig. 1.  Duplex scanning demonstrating pseudoaneurysm in the renal transplant.

 


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Fig. 2.  Transplant angiography demonstrating two pseudoaneurysms arising from an artery in the renal cortex.

 


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Fig. 3.  Embolization of pseudoaneurysms selectively with metal coils.

 
The majority of arteriovenous fistulae and pseudoaneurysms developing after allograft biopsy are either asymptomatic or show only transient symptoms [1,2]. However, life-threatening haematuria due to pseudoaneurysm, detectable by duplex scanning and angiography, has been reported following an open renal biopsy. On occasions, intra-renal arteriovenous shunting, managed successfully by embolization, has been thought to contribute to renal dysfunction and hypertension in such patients [1,2]. Superselective arterial embolization with metallic coils is effective [3].

Notes

Correspondence and offprint requests to: Mr A. Bakran, Link 9 C, Royal Liverpool University Hospital, Liverpool L7 8XP, UK. Email: ABakran{at}rlbuh\|[hyphen]\|tr.nwest.nhs.uk Back

References

  1. Barkhausen J, Verhagen R, Muller RD. Successful interventional treatment of renal insufficiency caused by renal artery pseudoaneurysm with concomitant arteriovenous fistula. Nephron2000; 85: 351–353[ISI][Medline]
  2. Bui BT, Oliva VL, Peloquin F, Harel C, Nicolet V, Carignan L. Correction of deteriorating renal function by superselective embolization of an arcuate renal artery pseudoaneurysm. J Urol1994; 152: 2087–2088[ISI][Medline]
  3. Tarif N, Dunne PM, Parachuru PR, Bakir AA. Life-threatening hematuria from an arteriovenous fistula complicating an open renal biopsy. Nephron1998; 80: 66–70[ISI][Medline]




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