{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T01:09:18Z","timestamp":1774314558959,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Spontaneous perirenal hemorrhage (SPH) and spontaneous renal rupture (SRR) are rare emergencies that can be radiologically indistinguishable when hematomas are large, especially in hemodialysis patients. We report a 53\u2010year\u2010old man on long\u2010term hemodialysis who developed acute left flank pain 19\u2009h after low\u2010molecular\u2010weight heparin. Contrast\u2010enhanced CT suggested SRR without tumor. Urgent angiography revealed no active extravasation; empiric selective renal artery embolization was performed, but pain and anemia progressed (hemoglobin nadir 54\u2009g\/L), prompting emergency nephrectomy. Gross and microscopic pathology demonstrated an intact renal capsule with hemorrhage confined to perirenal fat and no neoplasm, cyst rupture, aneurysm, or vasculitis, confirming SPH. Uremia\u2010associated vasculopathy and repeated anticoagulation likely increased vascular fragility; bleeding from perirenal fat with collateral supply (lumbar, adrenal, gonadal arteries) may explain embolization failure. Postoperatively, dialysis anticoagulation was temporarily switched to nafamostat mesylate and later safely resumed with low\u2010molecular\u2010weight heparin; at approximately 7\u2009months after surgery, hemoglobin was 109\u2009g\/L with no recurrence. This case underscores the limits of CT specificity in large hematomas, the need to consider extracapsular bleeding when embolization fails, the role of pathology for definitive diagnosis, and the importance of early surgical exploration and individualized anticoagulation in hemodialysis patients.<\/jats:p>","DOI":"10.1002\/ccr3.72008","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T06:03:25Z","timestamp":1770444205000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spontaneous Perirenal Hemorrhage Mimicking Renal Rupture in a Long\u2010Term Hemodialysis Patient: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7939-5073","authenticated-orcid":false,"given":"Zhen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nephrology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Urology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University)  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.942826"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hdi.12607"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-021-02424-9"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.220172"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2016.08.010"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.34172\/jsums.2021.32"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2021.1979038"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000330192"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.9734\/air\/2023\/v24i5953"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.10909"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14092986"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.04.045"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10061291"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003319718799967"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2464830"},{"key":"e_1_2_14_17_1","article-title":"Revised Surgical CAse REport (SCARE) Guideline: An Update for the Age of Artificial Intelligence","volume":"10","author":"Kerwan A.","year":"2025","journal-title":"Premier Journal of Science"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-017-1694-8"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemrpt.2024.100127"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2025.111190"},{"issue":"5","key":"e_1_2_14_21_1","first-page":"412","article-title":"Bilateral Spontaneous Perirenal Haemorrhage in a Patient on Haemodialysis","volume":"2","author":"Ku J. 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