Images in Nephrology (Section Editor: G. H. Neild) Spontaneous kidney rupture—an unusual complication of Wegener’s granulomatosis

A 51-year-old man had been suffering from blood-stained purulent sinusitis for 4 months. He had proteinuria of 2.62 g/24 h, microhaematuria and sero-logical evidence of inflammation (ESR: 92/135mm, CRP: 12mg/dl). When admitted to hospital with a suspected postinfectious glomerulonephritis, he com-plained of spontaneous colic-like pains in the left flank. Laboratory findings were as follows: serum total protein was 63 g/l and albumin, 24 g/l. Blood urea nitrogen was 20mmol/l and creatinine, 469 mmol/l. On the 17th day of admission he developed acute abdominal pain, combined with haemorrhagic shock. Hb fell rapidly from 10.5 to 4 g/dl. An urgent CT scan of the abdomen revealed perirenal haematoma with dubious contrast escape from the right renal capsule. On operation, this was found to be a rupture of the kidney with perirenal bleeding, which was treated without removing the kidney (Figure 1). No biopsy was taken, but serological tests showed antineutrophil cytoplasmatic antibodies (cANCA), indicating Wegener’s granulomatosis as the cause of renal insufficiency and spontaneous renal rupture. Postoperatively, the patient’s condition deteriorated fast and he died 2 days before surgery. Spontaneous renal rupture is rare, but may be the first sign of Wegener’s granulomatosis. To our knowledge, no case of spontaneous renal rupture due to Wegener’s granulomatosis has been reported in the medical literature. Our case had a similar presenta-tion to an acute abdomen, which is a perplexing problem for the physician. In our case, serological signs of marked inflammatory activity, urinary sedi-ments of nephritis and spontaneous retroperitoneal bleeding should suggest that, in addition to lupus erythematodes and panarteritis nodosa [1,2], Wegener’s granulomatosis be included in the differential diagnosis of spontaneous kidney rupture