Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil.
Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil.
Transplant Proc. 2021 Oct;53(8):2517-2520. doi: 10.1016/j.transproceed.2021.08.025. Epub 2021 Sep 21.
Wünderlich syndrome, or spontaneous atraumatic renal hemorrhage, is a clinical entity rarely described in the native kidney of patients who have undergone renal transplant. Although its manifestation is quite similar in reported cases, it may present few symptoms, from bleeding of unidentified etiology to dramatic pictures associated with hypovolemic shock. There are few reports of spontaneous hemorrhage of a native kidney after kidney transplantation.
We present a 38-year-old male patient who developed hemorrhage of a ruptured native kidney after a late renal transplantation. We analyze what has been reported in the literature and highlight the possibility of this complication after kidney transplantation. Imaging exams and surgical specimen demonstrated the presence of ruptured angiomyolipoma in the patient's native right kidney. The postoperative period was not complicated, with a benign clinical evolution.
Although rare in patients who have undergone renal transplant, it is justified to suggest Wünderlich syndrome in the presence of acute flank pain, abdominal tenderness, and signs of internal bleeding (Lenk's triad), with unexplained hemoglobin drop.
Wünderlich 综合征，或自发性非外伤性肾出血，是一种在接受肾移植的患者的原生肾脏中很少描述的临床实体。尽管其表现形式在已报道的病例中非常相似，但它可能表现出很少的症状，从不明原因的出血到与低血容量性休克相关的戏剧性表现。关于肾移植后自发性原生肾出血的报道很少。
我们报告了一例 38 岁男性患者，在晚期肾移植后发生破裂的原生肾出血。我们分析了文献中的报道，并强调了肾移植后发生这种并发症的可能性。影像学检查和手术标本显示患者的原生右肾存在破裂的血管平滑肌脂肪瘤。术后期间无并发症，临床转归良好。
尽管在接受肾移植的患者中很少见，但在出现急性腰痛、腹部压痛和内部出血迹象（Lenk 三联征），同时伴有不明原因的血红蛋白下降时，应合理考虑 Wünderlich 综合征。
