SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Wunderlich Syndrome Complicated by Page Kidney in a Patient With Pyelonephritis

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This case report describes a 43-year-old woman with type II diabetes, hypertension, chronic kidney disease stage 3, and prior pyelonephritis complicated by <em>E. coli</em> bacteremia who presented with vomiting, anorexia, fever, chills, mild abdominal discomfort, tachycardia, and severe hypertension. Her initial labs showed leukocytosis, anemia, and acute kidney injury, with urinalysis suggestive of infection. Over the next several days, her hemoglobin and creatinine worsened significantly.

Abdominal CT revealed a large left subcapsular renal hematoma with hemorrhagic stranding in the perinephric space, consistent with Wunderlich syndrome (WS), a spontaneous nontraumatic renal hemorrhage. In this patient, the WS was complicated by Page kidney, where compression of the kidney by the hematoma triggered activation of the renin-angiotensin-aldosterone system, leading to hypertension rather than the hypotension more typically associated with hemorrhage.

The report emphasizes that the classic Lenk’s triad of flank pain, palpable mass, and shock is uncommon in WS; patients often present with nonspecific symptoms such as fever, nausea, and vomiting. It also notes that infection, including pyelonephritis, is a rare but important cause of WS. CT imaging is the preferred diagnostic modality.

Management may be conservative, especially with renin-angiotensin system blockade for Page kidney, but severe or complicated cases may require intervention. In this case, the patient underwent robotic-assisted left perinephric hematoma evacuation.

Overall, the case highlights the need to consider renal hematoma in patients with abdominal pain, renal dysfunction, and hypertension, particularly when pyelonephritis is present, because prompt recognition can guide appropriate management and prevent further renal injury.

Asset Subtitle

Jazmin F. Mexia Cabrales

Meta Tag

Author List Bettina Gabrielle Villano Tenorio, Franklin Liu, Jazmin F. Mexia Cabrales, Robert Thompson

Category Clinical Vignettes

Concept Wunderlich Syndrome

Concept Page Kidney

Concept Retroperitoneal Hemorrhage

Concept Hypertension

Concept CT Imaging

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Jazmin F. Mexia Cabrales

Track Adult

Keywords

Wunderlich syndrome

Page kidney

renal hematoma

pyelonephritis

hypertension

acute kidney injury

subcapsular hematoma

CT imaging

perinephric hemorrhage

renal hemorrhage

Wunderlich Syndrome

Page Kidney

Retroperitoneal Hemorrhage

Hypertension

CT Imaging