Acute Page Kidney and Renal Vein Thrombosis Secondary to Post-Biopsy Subcapsular Hematoma

Background: Major complications of percutaneous core needle biopsy are quite rare; however, renal transplant patients, especially those experiencing graft rejection, are high-risk for graft loss as a result. Renal subcapsular hematomas have the potential to compress the renal parenchyma and cause a secondary HTN, a process called acute Page kidney (APK). These hematomas can also compress the renal vascular, causing renal vein thrombosis. Case Presentation: A 63-year-old medically non-compliant African American female was admitted to the hospital for biopsy confirmed AMR. She underwent a deceased donor renal transplantation 3 years prior for ESRD secondary to DM and HTN. On hospital day 8, she developed RLQ abdominal pain over her transplant site. Her Hgb dropped from 7.8 to 7.1, her BP spiked at 183/78, and she ceased making urine. Ultrasound showed a large perinephric hematoma, which was collaborated by CT. Repeat labs revealed further decreased Hgb (6.2) and increased Cr (4.2). During surgery, a small active bleeding site was found on the biopsy side of the kidney after evacuation of the hematoma. Duplex U/S showed reversed arterial flow, minimal parenchymal perfusion, and no renal vein flow. The allograft was deemed non-viable and nephrectomy was performed. Patient was discharged in stable condition on hospital day 14 with follow-up for outpatient HD. Conclusions: This case highlights some rare complications of renal biopsy and serves as a reminder for practitioners to keep a low-threshold of suspicion when dealing with high-risk patients, such as those with AMR.