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 1
). Arteriography demonstrated two pseudoaneurysms arising from a cortical artery (Figure 2
). These pseudoaneurysms were embolized selectively with four metal coils (Figure 3
). 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. 2. Transplant angiography demonstrating two pseudoaneurysms arising from an artery in the renal cortex.
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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 
References
-
Barkhausen J, Verhagen R, Muller RD. Successful interventional treatment of renal insufficiency caused by renal artery pseudoaneurysm with concomitant arteriovenous fistula. Nephron2000; 85: 351353[ISI][Medline]
-
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: 20872088[ISI][Medline]
-
Tarif N, Dunne PM, Parachuru PR, Bakir AA. Life-threatening hematuria from an arteriovenous fistula complicating an open renal biopsy. Nephron1998; 80: 6670[ISI][Medline]