Percutaneous Drainage of Renal Subcapsular Fluid Collections: A Two-Case Series
Abstract
Renal subcapsular fluid collections may compress the renal parenchyma, impair cortical perfusion, and contribute to secondary hypertension. Evidence guiding management remains limited, particularly where advanced laparoscopic approaches are unavailable. Case 1 was a 26-year-old man with steroid-sensitive nephrotic syndrome, blood pressure of 145/92 mmHg, creatinine of 1.2 mg/dL (estimated glomerular filtration rate, 75 mL/min/1.73 m²), albumin of 2.2 g/dL, and bilateral subcapsular collections measuring 8 cm on the right and 5 cm on the left. Case 2 was a 63-year-old woman with end-stage renal disease secondary to cervical-cancer-related bilateral ureteric obstruction, blood pressure of 160/100 mmHg, blood urea nitrogen of 85 mg/dL, creatinine of 6.8 mg/dL, bilateral non-functioning kidneys, grade II hydronephrosis, and bilateral 6-cm collections. Both patients underwent ultrasound-guided bilateral percutaneous drainage using an 8-Fr pigtail catheter and Seldinger technique under local anesthesia with 160 mg of 2% lidocaine per side. Case 1 yielded 5,000 mL of whitish fluid from the right and 2,500 mL of clear fluid from the left. Case 2 yielded 2,000 mL from each side, with cultures reportedly growing Escherichia coli susceptible to ciprofloxacin. Oral antimicrobial therapy was administered, and prednisone was restarted in Case 1. One-month ultrasonography showed complete resolution without documented re-accumulation. Post-drainage blood pressure was 125/85 mmHg in Case 1 and 142/92 mmHg in Case 2. Serial blood pressure and laboratory assessments were unavailable; fluid biochemical, cytological, and microbiological analyses were not performed. Ultrasound-guided percutaneous drainage may be a feasible, minimally invasive, resource-sparing option for selected renal subcapsular fluid collections. Microbiological evaluation is important when infection is suspected. Further studies should incorporate standardized fluid analysis and objective pre- and post-drainage clinical assessment.
Keywords: Subcapsular renal fluid collection, Percutaneous drainage, Ultrasound-guided drainage, Renal compression, Interventional radiology
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DOI: http://dx.doi.org/10.30829/contagion.v8i3.29565
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