UROL_Montage.pdf


Pictorial Urology

8 Urology Journal   Vol 6   No 1   Winter 2009

Bilateral Spontaneous Perinephric Hematoma
Urol J. 2009;6:8. 

www.uj.unrc.ir

A 55-year-old man presented with a history of generalized swelling all over the body and uremic 
symptoms. Physical examination revealed pallor, anasarca, and hypertension. A gradual elevation of 
serum creatinine level from 1.6 mg/dL to 6.49 mg/dL was documented within 3 weeks. Urinalysis did 
not show any abnormal sign. Ultrasonography revealed the right kidney sized 9.5 × 3 cm and the left 
kidney, 10 × 4.9 cm, with large bilateral perinephric collections. Doppler ultrasonography revealed a 
1.3-cm midpole aneurysm in the right kidney and multiple left renal aneurysms. Computed tomography 
revealed heterogeneous bilateral collections with fascial thickening in the perirenal spaces suggestive 
of bilateral perirenal hematomas with bilateral renal artery aneurysms. He was subjected to bilateral 
renal angiography and coiling of the aneurysms. Perinephric collection was evacuated by flank incision. 
Subcapsular renal hematomas occur secondary to variable etiologies and Page kidney phenomenon can 
lead to kidney failure.(1) When occurs unilaterally, it can be managed expectantly, but Page kidney in a 
solitary unit or bilateral Page kidney can lead to acute kidney failure, necessitating intervention to avoid 
the irreversible kidney damage.(2)

Rahul Gupta, Syed Jamal Rizvi, Pranjal R Modi
Department of Urology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India 

E-mail: rajaguptadr@rediffmail.com

REFERENCES
1. Haydar A, Bakri RS, Prime M, Goldsmith DJ. Page kidney--a review of the literature. J Nephrol. 2003;16:329-33.

2. Matin SF, Hsu TH, Klein EA, Streem SB. Acute renal failure due to subcapsular renal hematoma in a solitary kidney: 
improvement after decompression. J Urol. 2002;168:2526-7.