Perinephric hematoma induced by factor Xa inhibitor in a patient with a vascular renal mass

AbstractPerinephric hematomas are known to present in the form of Lenk’s triad with acute flank pain, flank mass and hypovolemic shock. Here, we describe a case of perinephric hematoma occurring secondary to the use of anticoagulant therapy in the setting of a renal mass. To the best of our knowledge, this is the first reported case of a perinephric hematoma occurring secondary to the use of Apixaban. The patient was an 80 year old male with a history of the presence of a left sided vascular renal mass discovered seven years ago admitted from a peripheral health center with pneumonia and a dropping hemoglobin along with acute kidney injury. Evaluation of his course revealed the use of a Factor Xa inhibitor, namely Apixaban, for new onset atrial fibrillation. The patient was stabilized with multiple units of packed red blood cell transfusions. An abdominal computed tomography abdomen demonstrated a perinephric hematoma contained in the Gerotas fascia. Due to deranged renal function, the patient was managed conservatively and made a full recovery. This case highlights the challenges associated with the diagnosis of perinephric bleeds. The use of anticoagulation therapy in the setting of a pre-existing vascular lesion remains a dilemma.

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Pediatric renal pseudotumour

BJR|case reports ◽

10.1259/bjrcr.20200088 ◽

2020 ◽

pp. 20200088

Author(s):

David Ola ◽

Ravikumar Hanumaiah ◽

Anand Majmudar

Keyword(s):

Renal Mass ◽

Surgical Intervention ◽

Color Doppler ◽

Hypertensive Crisis ◽

Kidney Injury ◽

Renal Ultrasound ◽

Ultrasound Study ◽

Normal Renal Parenchyma ◽

History Of ◽

The Right

We present a case of 6-year-old female with history of respiratory distress who went into respiratory failure requiring intubation. Patient was subsequently found to be in hypertensive crisis with hyponatremic hypochloremic metabolic acidosis and acute kidney injury. Renal ultrasound was performed to find the cause of hypertension. The ultrasound study demonstrated lobulated isoechoic to hyper echoic mass-like lesion in the middle and lower pole of the right kidney with increased vascularity on Color Doppler examination. The renal mass was finally diagnosed as a pseudotumour, representing hypertrophied portion of the spared normal renal parenchyma in otherwise atrophic right kidney. Diagnosis was made using a combination of US, MRI, DMSA and CT angiography thus avoiding unnecessary surgical intervention.

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Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy

Case Reports in Urology ◽

10.1155/2014/975412 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Christopher Caputo ◽

Ziho Lee ◽

Andrew Harbin ◽

Daniel Eun

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Biopsy ◽

Partial Nephrectomy ◽

Renal Cell ◽

Renal Mass ◽

Preoperative Imaging ◽

Robotic Partial Nephrectomy ◽

History Of ◽

Perinephric Hematoma

We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN), a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures.

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Prophylaxis and management of venous thromboembolism during pregnancy and postpartum period

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2021.222 ◽

2021 ◽

Vol 15 (5) ◽

pp. 599-616

Author(s):

V. Ya. Khryshchanovich ◽

N. Ya. Skobeleva

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Pregnant Women ◽

Postpartum Period ◽

Anticoagulation Therapy ◽

Total Duration ◽

Factor Xa ◽

Pregnancy And Postpartum ◽

Routine Administration ◽

History Of

Introduction. Venous thromboembolism (VTE) is one of the lead causes for maternal mortality and morbidity during pregnancy in the majority of developed countries. The incidence rate of VTE per pregnancy-year increases during pregnancy and postpartum period about by 4-fold and at least 14-fold, respectively.Aim: to analyze and summarize current view on risk factors of thrombotic events during gestation and to discuss recent guidelines for the management of venous thromboembolic complications during pregnancy and postpartum, by taking into account a balance between risks and benefits of using anticoagulants.Materials and Methods. The literature search covering the last 10 years was carried out in the electronic scientific databases RSCI, PubMed/MEDLINE, and Embase. While formulating a search strategy for evidence-based information, the PICO method (P = Patient; I = Intervention; C = Comparison; O = Outcome) and the key terms “venous thromboembolism” and “pregnancy” were used.Results. Risk factors were found to include a personal history of VTE, verified inherited or acquired thrombophilia, a family history of VTE and general medical conditions, such as immobilization, overweight, varicose veins, some hematological diseases and autoimmune disorders. VTE is considered being potentially preventable upon prophylactic administration of anticoagulants, but no high confidence randomized clinical trials comparing diverse strategies of thromboprophylaxis in pregnant women have been proposed so far. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparins (LMWH) represent the anticoagulant treatment of choice for VTE during pregnancy. Once- and twice-daily dosing regimens are acceptable. However, no evidence suggesting benefits for measurement of factor Xa activities and consecutive LMWH dose adjustments to improve clinical outcomes are available. In case of uncomplicated pregnancy-related VTE, no routine administration of vitamin K antagonists, direct thrombin or factor Xa inhibitors, fondaparinux, or danaparoid is recommended. Lactating women may switch from applying LMWH to warfarin. Anticoagulation therapy should be continued for 6 weeks postpartum with total duration lasting at least for 3 months.Conclusion. VTE is a challenging task in pregnant women expecting to apply a multi-faceted approach for its efficient solution by taking into account updated recommendations and personalized patient-oriented features.

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Andexanet Alfa Use for Small Bowel Obstruction Patient With History of Sugiura Procedure

Military Medicine ◽

10.1093/milmed/usab151 ◽

2021 ◽

Author(s):

Adam K Brust ◽

Amarateedha P LeCourt ◽

Derek A Benham ◽

Jonathan R Gower ◽

Sean D Birmingham

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Factor Xa ◽

Factor Xa Inhibitor ◽

Jak2 Mutation ◽

History Of ◽

Andexanet Alfa ◽

Sugiura Procedure ◽

Emergent Laparotomy

ABSTRACT This case report is about a 51-year-old active duty male with JAK2 mutation and medical history significant for prehepatic portal hypertension from portal vein thrombus on lifelong anticoagulation with rivaroxaban, an oral factor Xa inhibitor, presenting with closed-loop small bowel obstruction requiring emergent laparotomy. We present this surgical case as it required emergent reversal of the oral factor Xa inhibitor with andexanet alfa.

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Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

Revista de Chimie ◽

10.37358/rc.18.2.6110 ◽

2018 ◽

Vol 69 (2) ◽

pp. 375-378

Author(s):

Catalin Pricop ◽

Ileana Adela Vacaroiu ◽

Daniela Radulescu ◽

Daniel Andone ◽

Dragos Puia

Keyword(s):

Renal Impairment ◽

Serum Creatinine ◽

Young Patients ◽

Kidney Injury ◽

Contralateral Kidney ◽

Reactive Protein ◽

Ureteral Lithiasis ◽

Unilateral Hydronephrosis ◽

Duration Of Hospitalization ◽

History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

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A meta‐analysis of andexanet alfa and prothrombin complex concentrate in the treatment of factor Xa inhibitor–related major bleeding

Research and Practice in Thrombosis and Haemostasis ◽

10.1002/rth2.12518 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Tessa Jaspers ◽

Kimberly Shudofsky ◽

Menno V. Huisman ◽

Karina Meijer ◽

Nakisa Khorsand

Keyword(s):

Major Bleeding ◽

Prothrombin Complex Concentrate ◽

Meta Analysis ◽

Factor Xa ◽

Factor Xa Inhibitor ◽

Andexanet Alfa

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SARS-CoV-2 infection and recurrence of anti-glomerular basement disease: a case report

BMC Nephrology ◽

10.1186/s12882-021-02275-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Alexander Winkler ◽

Emanuel Zitt ◽

Hannelore Sprenger-Mähr ◽

Afschin Soleiman ◽

Manfred Cejna ◽

...

Keyword(s):

Basement Membrane ◽

Glomerular Basement Membrane ◽

Plasma Cells ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Pulmonary Involvement ◽

Pulmonary Haemorrhage ◽

Basement Membranes ◽

High Avidity ◽

History Of

Abstract Background Anti-glomerular basement membrane disease (GBM) disease is a rare autoimmune disease causing rapidly progressive glomerulonephritis and pulmonary haemorrhage. Recently, an association between COVID-19 and anti-glomerular basement membrane (anti-GBM) disease has been proposed. We report on a patient with recurrence of anti-GBM disease after SARS-CoV-2 infection. Case presentation The 31-year-old woman had a past medical history of anti-GBM disease, first diagnosed 11 years ago, and a first relapse 5 years ago. She was admitted with severe dyspnoea, haemoptysis, pulmonary infiltrates and acute on chronic kidney injury. A SARS-CoV-2 PCR was positive with a high cycle threshold. Anti-GBM autoantibodies were undetectable. A kidney biopsy revealed necrotising crescentic glomerulonephritis with linear deposits of IgG, IgM and C3 along the glomerular basement membrane, confirming a recurrence of anti-GBM disease. She was treated with steroids, plasma exchange and two doses of rituximab. Pulmonary disease resolved, but the patient remained dialysis-dependent. We propose that pulmonary involvement of COVID-19 caused exposure of alveolar basement membranes leading to the production of high avidity autoantibodies by long-lived plasma cells, resulting in severe pulmonary renal syndrome. Conclusion Our case supports the assumption of a possible association between COVID-19 and anti-GBM disease.

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A history of uremic toxicity and of the European Uremic Toxin Work Group (EUTox)

Clinical Kidney Journal ◽

10.1093/ckj/sfab011 ◽

2021 ◽

Cited By ~ 1

Author(s):

Raymond Vanholder ◽

Angel Argiles ◽

Joachim Jankowski ◽

Keyword(s):

Work Group ◽

Target Identification ◽

Kidney Injury ◽

Uremic Toxins ◽

Uremic Toxin ◽

Post Translational Modifications ◽

History Of ◽

Advanced Stages ◽

Uremic Syndrome

Abstract The uremic syndrome is a complex clinical picture developing in the advanced stages of chronic kidney disease (CKD) resulting in a myriad of complications and a high early mortality. This picture is to a significant extent defined by retention of metabolites and peptides that with a preserved kidney function are excreted or degraded by the kidneys. In as far as those solutes have a negative biological/biochemical impact, they are called uremic toxins. Here, we describe the historical evolution of the scientific knowledge about uremic toxins and the role played in this process by the European Uremic Toxin Work Group (EUTox) during the last two decades. The earliest knowledge about a uremic toxin goes back to the early 17th century when the existence of what later would appear to be urea was recognized. It cost about two further centuries to better define the role of urea and its link to kidney failure and one more century to identify the relevance of post-translational modifications caused by urea such as carbamoylation. The knowledge progressively extended, especially from 1980 on, by the identification of more and more toxins and their adverse biological/biochemical impact. Progress of knowledge was paralleled and impacted by evolution of dialysis strategies. The last two decades, when Insights grew exponentially, coincides with the foundation and activity of EUTox. In the final section we summarize the role and accomplishments of EUTox and the part it is likely to play in future action, which should be organized around focus points like biomarker and potential target identification, intestinal generation, toxicity mechanisms and their correction, kidney and extracorporeal removal, patient-oriented outcomes, and toxin characteristics in acute kidney injury and transplantation.

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