SPONTANEOUS RUPTURE OF THE KIDNEY - A COM PLICATION OF PANARTERITIS-NODOSA

Besides renal cell carcinomas and angiomyolipomas panarteritis nodosa (PAN) is a common underlying disorder for spontaneous perirenal hemato mas (SPH). Herein we report on 3 cases with PAN associated kidney rupt ures where diagnosis of PAN was not known before in 2 instances. The h ematoma was identified by computerized tomography (CT) in all patients , nevertheless CT failed to reveal the underlying disorder in any case . In this situation angiography was extremely valuable visualizing mul tiple renal microaneurysms that are typical for PAN. Operative explora tion and drainage of the hematoma was necessary in two patients becaus e of hemodynamic instability. In one patient bleeding could be control led after an immediate immunosuppressive therapy with prednisone and c yclophosphamide. Due to the high incidence of PAN associated spontaneo us perirenal hematomas angiography should be performed in all cases wi th unclear SPH after CT evaluation. In our opinion an immediate surgic al intervention is only indicated in cases with hemodynamic instabilit y. Otherwise a conservative approach including immediate immunosuppres sion seems justified. Nephrectomy should be avoided whenever possible.