D O’HARA1, H CHEIKH HASSAN1
1Wollongong Renal Department, Wollongong, Australia
Background: Haemorrhagic complications of renal biopsy include perinephric haematoma formation in 11.6% of cases, macroscopic haematuria in 3.5% of cases, bladder outlet obstruction from blood clots in 0.3% of cases, and a 0.01% risk of nephrectomy. There is only a single published case of post-biopsy ureteric obstruction due to haematuria.
Case Report: A 60 year-old female underwent an outpatient right renal biopsy for investigation of gradually declining renal function (estimated glomerular filtration rate 82mL/min to 68 mL/min over 1 year), a urine protein:creatinine ratio of 80mg/mmol and microscopic haematuria, on a background of untreated mild systemic lupus erythematosis. Haemoglobin, platelet count, coagulation studies and blood pressure were normal prior to biopsy, and she was not taking anticoagulants. Post biopsy she developed macroscopic haematuria that abated by the afternoon with hydration. She was discharged home with instructions to re-present if bleeding recurred. She was contacted the following day and she reported no further haematuria, and was well apart from 1 hour of right-sided flank pain during the night. Five days post-biopsy she awoke during the night with severe flank pain and with recurrence of macroscopic haematuria. A non-contrast abdominal CT scan identified moderate to severe right hydronephrosis with hyperdensity within the right ureter consistent with a blood clot. She underwent a right ureteric stent insertion, with relief of symptoms. The renal biopsy showed no large arteries, as well as non-specific mildly increased mesangial cellularity and expansion.
Conclusions: Ureteric obstruction from post-biopsy haematuria is a rare but clinically important condition to recognise and treat. It could occur up to 5 days post biopsy. It could be considered as a component of informed pre-biopsy consent.
Dr Daniel O’Hara is a second-year renal Advanced Trainee in the East Coast Renal Network. He has a keen interest in general nephrology, dialysis, obstetric medicine and global renal health.