AN UNUSUAL CAUSE OF HAEMATURIA IN PREGNANCY
Michaela Cheng1, Cindy Bach1, Patrick Cooney1 1Bendigo Health, Department of Nephrology, Bendigo, Victoria, Australia
Abstract
Background
Renal arteriovenous malformations (AVM) are an unusual cause of haematuria. They pose a challenge diagnostically and therapeutically especially in pregnancy.
Case report
A 33 year old female, G3P1, presents with frank haematuria at 10-weeks gestation.
During her first pregnancy 18 months prior, she had macroscopic haematuria and right flank pain at 35-weeks gestation. This was associated with hypertension, renal impairment, and 9g of proteinuria. She was induced due to worsening hypertension, thought to be pre-eclampsia. Her glomerulonephritis screen was negative for ANA, ENA, ANCA, anti-GBM antibodies, and normal complement levels. ds-DNA antibodies were mildly elevated at 14 IU/mL. A renal tract ultrasound was performed showing right sided hydronephrosis, which resolved on repeat scanning 5 weeks post-partum. A flexible cystoscopy performed was unremarkable.
This presentation, her haematuria was associated with clots and urinary retention. Her haemoglobin level dropped from 125 g/L to 72 g/L and required 2 units of packed red cells. She had no proteinuria, and a renal tract ultrasound and Doppler showed a moderately dilated right pelvicalyceal system which was thought to be pregnancy related, and a normal left kidney.
A CT renal angiogram was performed due to suspicion for a right renal vessel bleed, showing an AVM in the upper pole of the right kidney with early opacification of a large renal vein and associated impaired nephrogram. Angio-embolisation of right renal vessels was done with resolution of haematuria.
Conclusion
Renal AVMs are rare in the obstetric population (less than 0.04%) that require prompt treatment as significant haematuria causing blood loss pose foetal and maternal endangerment. Furthermore, risk of radiation exposure needs to be balanced with the benefits of diagnosis and appropriate treatment.
Biography
Bio to come