Abstract: SA-PO214
Calyceal Rupture of Horseshoe Kidney Following Chemotherapy
Session Information
- Onconephrology: Immunological Cross-Talk
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- 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
Introduction
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.
Discussion
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.