Abstract: FR-PO0239
Delayed Renal Hemorrhage Due to Pseudoaneurysm Following Percutaneous Kidney Biopsy: A Case Series and Review of Management
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Paswan, Rishi, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
- Rodriguez Lopez, Armando Francisco, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
- Qadir, Neela, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
- Myers, Iskra, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
Introduction
Percutaneous renal biopsy is a cornerstone diagnostic tool in nephrology, yet it carries a recognized risk of significant hemorrhage. While most bleeding events occur within 24 hours, delayed hemorrhage, particularly due to renal artery pseudoaneurysm, remains a rare but clinically significant complication.
Case Description
We present two cases of delayed renal hemorrhage manifesting over one week following native kidney biopsy.
Case 1: A 60-year-old female with post-streptococcal glomerulonephritis underwent an uncomplicated ultrasound-guided renal biopsy. Two weeks later, she presented with flank pain and anemia. Imaging revealed a large right renal subcapsular hematoma and pseudoaneurysm. Angiography identified active bleeding from a lower pole interlobar artery and a pseudoaneurysm in a tiny arcuate artery, both of which were successfully treated with microcoil embolization.
Case 2: A 45-year-old male with longstanding resistant hypertension underwent CT-guided renal biopsy for rapidly progressive renal failure and suspected hypertensive thrombotic microangiopathy vs nephrosclerosis. Although initially asymptomatic, he developed right flank pain and anemia ten days post-biopsy. Imaging confirmed a subcapsular hematoma and two pseudoaneurysms in the lower pole of the right kidney. Angiographic embolization was performed with clinical improvement and cessation of hemorrhage.
Discussion
Discussion: Delayed hemorrhage after percutaneous renal biopsy is uncommon, with pseudoaneurysm formation being a particularly rare but serious complication. Risk factors include uncontrolled hypertension, decreased eGFR, arterionephrosclerosis, and small vessel arterial injury not immediately evident post-procedure. These cases underscore the importance of considering pseudoaneurysm in the differential diagnosis of post-biopsy anemia and pain beyond the initial 24–48 hours. Prompt imaging and interventional radiology-guided embolization can be both diagnostic and therapeutic.
Conclusion: Delayed hemorrhagic complications from renal pseudoaneurysms following biopsy, though uncommon, require high clinical suspicion and timely intervention. These cases exemplify the utility of angiographic embolization in managing such late-onset complications effectively.