NDT Advance Access originally published online on April 28, 2008
Nephrology Dialysis Transplantation 2008 23(8):2688-2689; doi:10.1093/ndt/gfn227
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Coiled-coiled domains as a mechanism to stop haemorrhage after renal biopsies
Franz-Volhard Clinic, Medical Faculty of the Charité, HELIOS Klinikum-Berlin, Berlin, Germany
Correspondence and offprint requests to: Friedrich C. Luft, Schwanebecker Chausee 50, Berlin 13125, Germany. E-mail: luft{at}charite.de; fluft{at}berlin.helios-kliniken.de
Keywords: coils; complications of kidney biopsy; embolization; renal biopsy
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Introduction |
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 Top Introduction Case reportConclusionsReferences |
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Nephrocystin (NPHP1), the gene for nephronophthisis type 1, is a protein featuring a coiled-coil domain [1]. The coiled coil is a common structural motif formed by
3–5% of all amino acids in proteins [2]. Nowadays, it is vital that busy nephrologists know such things. We recently were faced with a nephrological process that also relied on coiled domains, a more common occurrence but never before described for this purpose. |
Case report |
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TopIntroductionCase reportConclusionsReferences |
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A 74-year-old woman underwent a routine percutaneous left renal biopsy at another hospital, the results of which were consistent with pauci-immune rapidly progressive glomerulonephritis. She had been admitted because of progressive dyspnea and haemoptysis. The creatinine concentration was 157 µmol/l, and she had protein in her urine. Heart failure was also observed since her pro-brain natriuretic peptide (Pro-BNP) level was 127 000 pg/ml (normal <194 pg/ml). She had antibodies against neutrophil myeloperoxidase (P-ANCA).
The woman was referred to our unit because of shock, a few hours after the procedure. The patient received volume resuscitation in the admitting room, and an abdominal CT was performed that revealed a large (>1.5 l) left retroperitoneal haematoma. Her creatinine concentration had increased to 303 µmol/l. Our urologists were reluctant to operate upon this unstable patient. We next decided to identify the bleeding site. An overview aortogram revealed a peculiar blush outside the left renal capsule. With closer focus, after display of the left renal artery, the epigastric inferior artery, and the coeliac axis had not helped us, we identified the blush as probably emanating from a left lower intercostal artery (Figure 1A). We successfully ‘coiled’ the structure (Figure 1B). After a rocky hospital course that included multiple haemodialyses for renal failure, the patient gradually recovered. Her heart failure was based on poor systolic and diastolic function. Prednisone and cyclophosphamide were given for her primary disease, and she left the hospital with a surprising serum creatinine of 133 µmol/l.
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Conclusions |
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TopIntroductionCase reportConclusionsReferences |
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Bleeding after kidney biopsies is a well-recognized complication. Embolization as a treatment for haemorrhage after a renal biopsy has been described, commonly for transplanted kidneys [3]. The coiling treatment has also been advocated under these circumstances [4]. However, reports regarding native kidneys have not appeared to our knowledge. Our surgical colleagues were reluctant to operate on this patient. They would have probably performed nephrectomy and haematoma drainage; the former halves renal function and the latter is fraught with hazards. We elected to follow an angiographic adventure since bleeding appeared to continue. We found a hitherto undescribed arterial injury. The kidney showed no evidence of damage, but the intercostal artery that was damaged also served to supply the spinal cord (Figure 1A). The lesion was ‘coiled’ successfully (Figure 1B), suggesting that this approach could be considered in other patients whose native renal biopsies go awry.
We are familiar with coiled-coil E-rich domains and try to train our younger colleagues in the latest molecular techniques [1,2]. However, sometimes it is worthwhile to recall that coils also work for other things [4].
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Acknowledgments |
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The authors thank colleagues involved in the care of this patient.
Conflict of interest statement. None declared.
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References |
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TopIntroductionCase reportConclusionsReferences |
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- Otto E, Kispert A, Schätzle S, et al. Neprhocystin: gene expression and sequence conservation between human, mouse and Caenorhabditis elegans. J Am Soc Nephrol (2000) 11:270–282.
[Abstract/Free Full Text] - Mason JM, Arndt KM. Coiled coil domains: stability, specificity, and biological implications. Chem Biochem (2004) 5:170–176.
- Perini S, Gordon RL, LaBerge JM, et al. Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome. J Vasc Interv Radiol (1998) 9:1011–1019.[Web of Science][Medline]
- Fays J, Hennequin L. Techniques and complications of interventional radiology in vascular diseases of transplanted kidneys. J Radiol (1994) 75:77–80. French.[Web of Science][Medline]
Accepted in revised form: 2. 4.08
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