Abstract:

Objective To analyze the treatment course, etiology, pathogenesis, clinical manifestations and potential causes for the misdiagnosis of Wunderlich syndrome (spontaneous renal rupture). Methods Spontaneous renal rupture during dialysis in a male patient on maintenance hemodialysis and the associated diagnostic and therapeutic treatments were retros pectively analyzed, and relevant literatures were reviewed. Results A 35-year-old male patient admitted for 10 months of maintenance hemodialysisandelevated blood pressure for 2 weeks. He developed the left-sided lumbar pain 30 minutes before the end of the hemodialysis session, which was associated with changes in body position and accompanied by distension of the lower left abdomen and vomiting. Following a comprehensive abdominal CT scan, spontaneous rupture of the left kidney was suspected. The patient was treated with an emergencyl percutaneous superselective arteriography and left renal artery embolization. After receiving successive postoperative treatments including continuous renal replacement therapy, anticoagulant-free hemodialysis, anti-infection therapy, and antihypertensive measures, the patient’s condition was improved and discharged. Conclusion Typically, the occurrence of renal rupture is associated with clear causative factors such as abdominal trauma. However, this patient developed non-specific abdominal pain without obvious causes that should be concerned. At this time, rare causes such as spontaneous renal rupture (Wunderlich syndrome) need to be considered. Due to the atypical manifestations of Wunderlich syndrome, its diagnosis is complicated and prone to the misdiagnosis of renal colic, further leading to delayed treatment and poor prognosis.

Key words: renal rupture, rupture, spontaneous, continuous renal replacement therapy, arterial occlusive disease, renal artery obstruction, renal artery embolization, maintenance hemodialysis, systemic inflammatory response syndrome