Wunderlich syndrome

Content sourced from Wikipedia, licensed under CC BY-SA 3.0.

Wunderlich syndrome is spontaneous bleeding around the kidney that happens without a injury. The bleeding stays in the space around the kidney under its capsule (the perinephric space).

Note: Some sources describe a reproductive tract condition called double uterus-hemivagina-renal agenesis as Wunderlich syndrome, but the correct term for that is Herlyn-Werner-Wunderlich syndrome. They are different problems.

Causes
- Most often due to a kidney tumor such as renal angiomyolipoma (AML) or renal cell carcinoma (RCC).
- Other causes include rupture of a kidney artery or aneurysm, arteriovenous malformations, or inflammatory/vascular conditions.

Symptoms
- Can range from mild abdominal or flank pain to severe shock from blood loss.
- Classic signs of a bleeding kidney (the Lenk triad) are flank pain, a flank mass, and low blood pressure, but this triad is not present in most patients.
- Some people may have little warning and only mild symptoms or blood in the urine.

Diagnosis
- Ultrasound or CT scan is used to confirm the bleeding.
- Blood tests may not clearly show Wunderlich syndrome, and hematuria (blood in urine) is not always present.

Treatment
- Depends on how badly the patient is bleeding.
- If stable: doctors may monitor the hematoma and patient’s vital signs.
- If unstable or rapidly bleeding: emergency surgery may be needed to remove part or all of the affected kidney (partial or total nephrectomy).
- Vascular procedures such as embolization can control bleeding without removing the kidney.
- In some cases of AML-related bleeding, kidney-sparing surgery (for example, robotic-assisted partial nephrectomy) may be considered.

In short, Wunderlich syndrome is a serious, nontraumatic kidney bleed that requires quick imaging and treatment tailored to how unstable the patient is, ranging from observation to surgery or angiographic procedures.