ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: SA-PO214

Calyceal Rupture of Horseshoe Kidney Following Chemotherapy

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Kang, Dasol, Weill Cornell Medicine, New York, New York, United States
  • Landa, Jonathan, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Park, James K., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Berman, Ellin, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. During embryogenesis, fusion of the kidneys prevents independent rotation and ascent. Vascular supply to HSK involves small arteries branching from aorta or renal arteries. Complications of HSK are pelviureteric junction obstruction, renal stones, infections, and tumors. Rupture of HSK has been reported in few case series and mainly due to trauma. Herein we describe a case of calyceal rupture of HSK in the setting of thrombocytopenia following chemotherapy.

Case Description

40-year-old male with HSK was diagnosed with acute myeloid leukemia. Baseline imaging showed left renal atrophy with hydronephrosis. Labs showed normal renal function, creatinine 0.8mg/dl. He was started on induction chemotherapy with cytarabine and daunorubicin. Ten days later, he developed abdominal pain, distension, and hematuria. He was hypotensive, platelet count 25 K/mcL, hemoglobin 6.9 g/dL. CT scan showed increased severe left hydronephrosis, large volume hemorrhagic fluid with dilated calyces and large perinephric/retroperitoneal hemorrhagic fluid consistent with calyceal rupture. (Figure. A) He received 2 units of blood and platelets and underwent emergent interventional radiology (IR) embolization to multiple arterial branches of the kidney. Future cycles of cytarabine were carefully planned with heme, renal, urology, and blood bank.


Bleeding and calyceal rupture was an unexpected potentially life threatening complication in this patient with known HSK. In patients planned for chemotherapy that can be complicated by thrombocytopenia, we recommend a) obtaining baseline renal imaging of HSK b) involving nephrology or urology early in the patient care and c) close monitoring and considering platelet transfusion with a higher platelet count threshold of 50K rather than 20K in collaboration with the blood bank given complicated arterial blood supply. In the event of hematuria and thrombocytopenia, we recommend early IR involvement for consideration of embolization.

(A) Calyceal rupture as described above (B) Repeat CT scan with decreased size of perirenal collection.