Abstract: SA-PO0096
Spontaneous Gross Hematuria Revealing a Renal Arteriovenous Malformation in a Young Adult: A Case Report
Session Information
- AKI: Clinical Diagnostics and Biomarkers
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Rayani, Raed, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Alhakamy, Mohammad Abdallah Y, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Alasmari, Abdullah Abdu, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Asiri, Ahmad Abdullah, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Asiri, Abdullah, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Alshehri, Mohammed, King Khalid University, Abha, Aseer Province, Saudi Arabia
Introduction
Gross hematuria has a broad differential—ranging from glomerular disease to infection, stones, and malignancy. In patients with persistent, painless bleeding after an extensive negative workup, uncommon vascular etiologies must be considered. We report a case of spontaneous renal arteriovenous malformation (AVM) presenting as refractory hematuria. Notably, an extensive glomerulonephritis panel (ANA, ANCA, complement C3/C4, anti–GBM) and urine cytology were all negative, and cystoscopy revealed no bladder source.
Case Description
A 31-year-old man with no trauma history presented at 2 AM with painless gross hematuria and retention. He was stable; WBC was 16, Hb dropped from 13.7 to 10.1 g/dL over five days, and creatinine peaked at 1.62 mg/dL before normalizing. Urinalysis, culture, cytology, and GN panel were negative. Noncontrast CT showed a bladder hematoma; cystoscopy revealed bleeding at the right ureteral orifice. CT angiography and digital subtraction angiography confirmed two mid- and lower-pole renal AVMs with early venous filling. Hematuria resolved immediately after coil embolization. He was discharged home,and follow-up was normal.
Discussion
This case underscores the importance of considering renal vascular lesions in the differential diagnosis of spontaneous, refractory hematuria, when both nephrological and urologic evaluations are unrevealing. Despite a thorough glomerulonephritis workup and, coupled with Inconclusive cystoscopic findings, the underlying cause was ultimately a renal AVF—an uncommon but critical diagnosis. CT angiography raised suspicion, and angiography confirmed and localized the AVFs,allowing for targeted coil embolization. The intervention achieved immediate hemostasis, prevented further anemia, and preserved renal function. Early recognition and prompt angiographic assessment of vascular etiologies can markedly reduce morbidity in patients with unexplained hematuria.
Bladder hematoma on first presentation