Real-Time Ultrasound Detection of Post-Stenting Renal Hemorrhage Causing Transient Page Kidney Physiology

Abstract

Renal hemorrhage following renal artery stenting is rare and typically diagnosed by computed tomography angiography (CTA) or digital subtraction angiography (DSA). We present a unique case of dynamic duplex ultrasound identification of active renal arterial bleeding originating from the upper pole of the right kidney, with extravasation into the perinephric space, immediately following stent placement for bilateral renal artery stenosis. The bleed was visualized in real time as an arterial jet extravasating into the perinephric space, accompanied by concurrent hematoma formation. Hemodynamic compromise followed, necessitating intensive care unit (ICU) admission and close monitoring. To our knowledge, this is the first reported case in which duplex ultrasound dynamically visualized active extrarenal hemorrhage immediately following renal artery stenting, providing the initial and decisive evidence prior to confirmatory imaging. This case highlights the potential of duplex ultrasound to expedite diagnosis and guide early management of post-procedural vascular complications, reinforcing its diagnostic value in vascular surveillance and the importance of early recognition of this rare but serious complication.