Year: 2025
Type: article
Study design: Case Report
Abstract: Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich Syndrome (WS) is a rare disease, characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces, without a history of prior trauma. It can be a life-threatening condition due to hemorrhagic shock, consequently, prompt diagnosis and therapeutic approach are essential for favorable outcomes. Treatment ranges from conservative management to surgical intervention. The most common etiologies are neoplasms, vascular diseases but it can be also observed in patients undergoing hemodialysis, especially those with acquired cystic kidney disease or renal cell carcinoma. However, patients with CKD, on particular those on dialysis, have a paradoxical hemostatic potential with increased rates of bleeding, so WS may occur even without the so-called common risk factors. The multifactorial pathogenesis in these patients includes specific coagulation abnormalities and the impaired architectonics of the renal tissue, as well as the use of antithrombotic agents. Case Presentation: We present a case report of a 62-year-old male on chronic dialysis who developed a sudden right-sided lumbar pain and hematuria during dialysis without evidence of prior trauma. Imaging revealed a large subcapsular hematoma of the right kidney. Despite conservative treatment, his condition worsened and the hematoma enlarged, requiring emergency nephrectomy. Pathology confirmed extensive hemorrhage in a nephrosclerotic kidney. Postoperatively, his condition gradually improved. Conclusions: This case highlights the importance of considering WS in hemodialysis patients, and should be included in differential diagnosis of acute abdominal pain.
Language: English
Topic: Case Reports on Hematomas
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,689
OpenAlex ID: W4412918550