Delayed ureteric obstruction secondary to blood clot following renal biopsy: Case report and literature review.

RATIONALE

Hemorrhage is a frequent complication following renal biopsy, whereas ureteral obstruction secondary to blood clot is an uncommon but significant adverse event. Presently, such obstructions typically manifest within the first-week postbiopsy; however, there are no documented cases of delayed-onset ureteral obstruction secondary to blood clots.

PATIENT CONCERNS

A 58-year-old male patient was admitted to Shaoxing Second Hospital with a 2-month history of recurrent bilateral lower extremity edema. He was diagnosed with nephrotic syndrome and subsequently underwent a renal biopsy. After a renal biopsy on day 19, the patient developed abdominal pain and hematuria. Follow-up examinations revealed a serum creatinine level of 181 μmol/L, and an abdominal computed tomography scan demonstrated a blood clot in the mid-portion of the right ureter.

DIAGNOSES

The patient was diagnosed with ureteric obstruction and acute renal failure.

INTERVENTIONS

The patient initially underwent bladder irrigation therapy; however, as there was no observable improvement in the condition after 48 hours, the decision was made to perform a transurethral ureteric stent placement.

OUTCOMES

The patient experienced immediate relief of abdominal pain following the procedure. On postoperative day 3, renal function had normalized. Seven days after surgery, the patient's hematuria had completely resolved, and he was discharged from the hospital. Two weeks later, the ureteral stent was removed during an outpatient visit. During the 6-month follow-up period, the patient remained in excellent health with no complications.

LESSONS

This case represents the first documented instance of delayed secondary ureteral obstruction due to blood clots following renal biopsy in China. When symptoms such as hematuria and flank pain occur after the procedure, ureteric obstruction should be highly suspected. Early diagnosis and prompt treatment are critical for optimizing patient outcomes.