UCLA-Kern Medical, Bakersfield, CA, USA.
Ross University, Miramar, FL, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620918098. doi: 10.1177/2324709620918098.
Spontaneous bilateral renal subcapsular hematoma is a rare condition. On literature review, only 2 case reports have elucidated possible etiologies for such a presentation; however, no definite conclusions have been made. We present a rare case of a 52-year-old female with diabetes mellitus type 2, chronic kidney disease stage 4, hypertension, hyperlipidemia, prior traumatic brain injury via motor vehicle accident, who presented to our hospital with diabetic ketoacidosis and clinical signs of pyelonephritis; subsequently, imaging demonstrated spontaneous bilateral renal subcapsular hematoma. Risk factors for the rare presentation in this patient included pyelonephritis, history of bilateral ureteral stent placement, and a remote history of a mild unilateral renal laceration secondary to a motor vehicle accident. Typically, patients with this condition achieve spontaneous resolution with conservative management. Our patient initially presented with diabetic ketoacidosis and pyelonephritis but gradually developed retroperitoneal bleeding and hemorrhagic shock. Our patient's critical condition required close monitoring in an intensive care unit and a more invasive approach including unilateral left renal artery embolization followed by a unilateral left nephrectomy. The patient ultimately recovered and continued to be followed outpatient without any serious long-term complications.
自发性双侧肾包膜下血肿是一种罕见的情况。在文献回顾中，仅有 2 例病例报告阐明了这种表现的可能病因；然而，尚未得出明确的结论。我们报告了一例罕见的病例，一名 52 岁女性，患有 2 型糖尿病、慢性肾脏病 4 期、高血压、高血脂症，曾因机动车事故导致外伤性脑损伤，因糖尿病酮症酸中毒和肾盂肾炎的临床迹象而就诊于我院；随后，影像学检查显示自发性双侧肾包膜下血肿。导致该患者这种罕见表现的危险因素包括肾盂肾炎、双侧输尿管支架置入史以及机动车事故导致的轻微单侧肾裂伤的远期病史。通常情况下，该病症患者通过保守治疗可实现自发性缓解。我们的患者最初表现为糖尿病酮症酸中毒和肾盂肾炎，但逐渐发展为腹膜后出血和失血性休克。该患者的危急病情需要在重症监护室进行密切监测，并采取更具侵袭性的方法，包括单侧左肾动脉栓塞，随后进行单侧左肾切除术。患者最终康复并继续在门诊接受随访，没有出现任何严重的长期并发症。
