Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Int Urol Nephrol. 2020 Mar;52(3):423-429. doi: 10.1007/s11255-019-02333-9. Epub 2019 Nov 4.
To assess clinical presentation and outcomes of different treatment strategies in cases of spontaneous renal hemorrhage (SRH).
A retrospective analysis of patients with SRH between 2000 and 2018 was performed. Patients' demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of the success of conservative treatment. The secondary outcome was to assess the long-term renal function outcome comparing serum creatinine, e GFF, and CT-assessed renal volume at last follow-up with baseline values.
The study included 42 (23 males and 19 women) patients with mean ± SD age was 48.1 ± 17.8 years. Conservative management was successful in 19 (46%) patients. Trans-arterial embolization (TAE) was performed in 13 patients (30%) to control active bleeding. Ten patients (25%) required surgical exploration and nephrectomy. Lower serum creatinine (P = 0.003), higher prothrombin concentration (P = 0.04), lower hematoma size (P = 0.02), and non-AML lesions (P = 0.03) were independent predictors of conservative management success. Unlike the TAE-treated group, serum creatinine increased significantly (P = 0.04) with a significant decrease in e-GFR (P = 0.02) and renal volume (P < 0.001) of affected kidneys at last follow-up after conservative treatment.
Although SRH is a life-threatening condition, conservative treatment is successful in a certain subset of patients. However, it is associated with significant deterioration of the affected kidney function as well as renal volume.
评估自发性肾出血（SRH）不同治疗策略的临床表现和结局。
对 2000 年至 2018 年期间的 SRH 患者进行回顾性分析。检索患者的人口统计学、临床表现、实验室和影像学检查以及不同的治疗方案。主要结局是评估保守治疗成功的预测因素。次要结局是比较最后随访时的血清肌酐、eGFR 和 CT 评估的肾脏体积与基线值，评估长期肾功能结局。
该研究纳入了 42 名（23 名男性和 19 名女性）患者，平均年龄为 48.1±17.8 岁。19 名（46%）患者采用保守治疗成功。为控制活动性出血，对 13 名患者（30%）进行了经动脉栓塞术（TAE）。10 名患者（25%）需要进行手术探查和肾切除术。较低的血清肌酐（P=0.003）、较高的凝血酶原浓度（P=0.04）、较小的血肿大小（P=0.02）和非 AML 病变（P=0.03）是保守治疗成功的独立预测因素。与 TAE 治疗组不同，接受保守治疗后，血清肌酐显著升高（P=0.04），eGFR 显著下降（P=0.02），受影响肾脏的体积显著减小（P<0.001）。
尽管 SRH 是一种危及生命的疾病，但在一定的患者亚组中，保守治疗是成功的。然而，它与受影响肾脏功能以及肾脏体积的显著恶化有关。
