Dr ZHUO LIN NG1, Dr JEFFREY WONG1, Dr GOVIND NARAYANAN1, Dr ANANTHAKRISHNAPURAM ARAVINDAN1, Dr HARI NANDAKOBAN1,2
1Liverpool Hospital, Liverpool, Australia, 2University of New South Wales, Sydney, Australia
Background:
Lumbar artery puncture and haemorrhage following renal biopsy is an exceedingly rare complication of clinical significance. Only a few cases has been reported in the literature to date.
Case Report:
We report a case of a 62-year-old man who underwent an ultrasound-guided percutaneous renal biopsy for suspected drug-induced tubulointerstitial nephritis. He initially presented in a hyperosmolar hyperglycaemic state precipitated by lower limb osteomyelitis. He was treated with a one-week course of high dose penicillin-based antimicrobial therapy and developed dialysis-dependent renal failure with a serum creatinine elevation from 150umol/L to 833umol/L.
A standard 16-G Bard automated core biopsy gun was utilized under direct visualization with a curvilinear ultrasound probe. The left kidney was biopsied with two cores obtained after four passes. There were no immediate complications post biopsy.
The following day, the patient reported mild flank tenderness with a subsequent haemoglobin drop from 81g/L to 64g/L. No superficial bruising or haematuria was noted. CT renal tract revealed a large left retroperitoneal haematoma approximately 10 x 5.5cm axially and 24cm craniocaudally extending from the perirenal space down to the left inguinal ring with associated displacement of the left kidney. Angiography studies identified arterial enhancement at left L2-3 level, representing a lumbar artery pseudoaneurysm and fistula between the lumbar artery and paired veins.
Successful embolization of the fistula was performed by interventional radiology via catheterization through the lumbar artery. This was achieved using 0.5cc of 1:1 glue and lipiodol.
Conclusions:
Extra-renal arterial injury is a rare but significant complication of renal biopsy. Angiographic imaging and embolization techniques can be effectively applied in management of significant bleeding.
Biography:
Dr Jolene ZL Ng is a Renal Advanced Trainee in Liverpool Hospital, New South Wales, Sydney.