Varela-Figueroa DA, González-Contreras IJ, García-Valencia NT, Andrés CV

Language: Spanish
References: 7
Page: 183-186
PDF size: 1274.64 Kb.

ABSTRACT

Introduction: spontaneous subcapsular or perinephric renal hemorrhage of non-traumatic etiology is a rare condition. The clinical picture is characterized by sudden onset flank pain, a palpable mass, and signs and symptoms of hypovolemic shock. In 1856, Wünderlich made the first clinical description, calling it "spontaneous apoplexy of the renal capsule". The etiology of this entity is varied. Xanthogranulomatous pyelonephritis is a rare, atypical and severe variant, that corresponds to less than 1% of chronic pyelonephritis. It is accompanied by partial or total destruction of the renal parenchyma. Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis, its main involvement is pulmonary, followed by genitourinary tuberculosis, representing 20 to 40% of cases of extrapulmonary tuberculosis. Among the genitourinary organs, kidney involvement is the most common, approximately 80%. Clinical case: a 52-year-old male patient with a history of genitourinary tuberculosis, currently inactive, with anatomical sequelae in the lower urinary tract. He presented with sudden onset pain located in the right flank, radiating to the ipsilateral iliac fossa, accompanied by hematuria. A complete blood count showed hemoglobin of 8 g/dL. The patient is currently in a kidney transplant protocol due to end-stage renal disease secondary to the sequelae of tuberculosis. A simple abdominal-pelvic computed tomography scan was performed, revealing a large right perinephric collection extending through the retroperitoneum to the ipsilateral iliac fossa. Subsequently, a new control complete blood count showed a decrease in hemoglobin to 6 g/dL and clinical signs of hypovolemia. Therefore, the patient was given a blood transfusion and a concomitant exploration and right nephrectomy were performed due to extensive renal rupture. The histopathological report describes xanthogranulomatous pyelonephritis with negative Ziehl-Neelsen staining. Conclusions: the clinical presentation manifests as a consequence of acute renal blood loss caused by a non-traumatic cause. Treatment options range from conservative treatment, partial nephrectomy or lumpectomy, to radical nephrectomy. The present case is the first described secondary to xanthogranulomatous pyelonephritis associated with renal tuberculosis. Wünderlich syndrome is a rare entity; however, it should be considered in the differential diagnosis, especially in patients with associated renal pathology.

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