A case of cardiac arrest due to a ruptured renal artery pseudoaneurysm, a complication of renal biopsy
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CASE REPORT
A case of cardiac arrest due to a ruptured renal artery pseudoaneurysm, a complication of renal biopsy Kasumi Satoh1 · Hajime Kaga2 · Manabu Okuyama1 · Tomoki Furuya1 · Yasuhito Irie1 · Koumei Kameyama1 · Toshiharu Kitamura1 · Hajime Nakae1 Received: 2 August 2020 / Accepted: 7 September 2020 © Japanese Society of Nephrology 2020
Abstract Renal artery pseudoaneurysms (RAPs) are a rare complication of percutaneous kidney biopsies that generally present as hematuria and back pain and are treated with angioembolization. A 60-year-old man was admitted to our emergency department for sudden left back pain. He was taking an oral anticoagulant for atrial fibrillation. He had undergone an ultrasoundguided percutaneous renal biopsy 26 days prior. We diagnosed him with hemorrhagic shock from the renal artery. Although he received a massive rapid blood transfusion, he went into cardiac arrest. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed and, within 10 min, the patient achieved return of spontaneous circulation and regained consciousness. Subsequently, angioembolization was successfully performed for a 12.5 mm × 5.9 mm pseudoaneurysm in the left renal inferior pole close to the site of the renal biopsy. A total of 1680 mL of red blood cells and fresh frozen plasma were administered respectively until hemostasis was completed. He was then treated with continuous hemodialysis in the intensive care unit (ICU) for 6 days. He stayed in the ICU for 9 days and was moved to the general ward with full neurological recovery and a sufficiently stable condition to be able to walk. In conclusion, clinicians should be aware of the possibility of severe hemorrhagic shock due to RAPs after renal biopsy. Moreover, even if the patient goes into cardiac arrest, there is a possibility of full recovery if REBOA is performed and angioembolization is completed. Keywords Renal biopsy · Cardiac arrest · Pseudoaneurysm · Resuscitative endovascular balloon occlusion of the aorta (REBOA) · Intensive care unit (ICU) · Emergency department (ED)
Introduction Renal artery pseudoaneurysms (RAPs) are a rare complication of percutaneous renal biopsy. While RAPs generally have a low risk of rupture, the mortality rate is 80% if rupture occurs [1]. The incidence and mortality associated with rupture of RAPs as a complication of percutaneous renal biopsy have not been established because they have not been reported in the literature [2]. There have been several reports of RAPs being diagnosed as a result of hematuria
and back pain [3, 4]; nevertheless, in some cases, it has been discovered incidentally and asymptomatically years later [1, 5]. Angioembolization is typically the treatment of choice for RAPs after percutaneous renal biopsy and has been performed safely [1–5]. We describe, to the best of our knowledge, the most severe and life-threatening reported case of post-renal biopsy RAPs. The novelty of this case is the successful treatment with resuscitative endovascular balloon occlusion of the aorta (REB
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