Coil embolization for renal arteriovenous fistula after percutaneous renal biopsy: a pediatric case report

Abstract

A 10-year-old female patient without significant prior medical history was evaluated by ultrasound-guided percutaneous renal biopsy for persistent, significant proteinuria initially noted during routine school urine screening. Following the biopsy, she developed gross hematuria, which resolved the next day, and perirenal hematoma, which subsequently declined in size; she was discharged three days after the procedure. However, 2 days later, she was readmitted with lower abdominal pain and gross hematuria. Contrast-enhanced computed tomography revealed hemorrhage originating from a renal arteriovenous fistula. Coil embolization was performed 2 days later, 7 days after the initial biopsy, resolving the symptoms. The arteriovenous fistula was presumed to have arisen from an inadvertent puncture near the renal hilum. Subsequent delayed-phase renal scintigraphy confirmed the preserved split renal function. Renal histopathology revealed minor glomerular abnormality, and she was finally diagnosed with orthostatic proteinuria. Although severe hemorrhagic complications requiring intervention are uncommon in pediatric patients undergoing renal biopsy, preparedness for prompt intervention is essential.