Spontaneous subcapsular and perinephric hemorrhage in end-stage kidney disease: clinical and CT findings.

Clinical, CT, and pathologic findings were analyzed in six patients with spontaneous subcapsular or perinephric hematomas complicating end-stage kidney disease. Renal failure had been managed by hemodialysis in four patients, by renal transplantation in one, and by conservative methods in one. All patients had nonspecific abdominal pain. CT clearly showed in all cases that the pain resulted from hemorrhage and also revealed the extent and location of hematomas. In addition, in four patients, CT showed underlying acquired cystic kidney disease that was the probable cause of hemorrhage. In one of these patients, CT also showed a renal cell carcinoma in the opposite kidney. Other causes for renal hemorrhage encountered in the series included renal infarction due to small vessel disease, heparinization during hemodialysis, and thrombocytopenia. Abdominal CT is a useful technique for evaluating patients with end-stage renal disease who have abdominal pain or who exhibit clinical evidence of blood loss.