Renal Artery Embolization for Haematuria in Lucknow

Blood in the urine, called haematuria, always needs a doctor to find the cause. It may show as red, pink or tea-coloured urine, or be found only on a urine test. Bleeding that causes no pain is not a reason to wait, because some serious causes are silent.

See a doctor the same day if the bleeding is heavy, if you pass clots, if you cannot pass urine, or if you have fever or severe pain in the side. Go to a hospital emergency department if you feel faint or dizzy.

Common causes are urine infection, kidney or bladder stones, an enlarged prostate, and tumours of the kidney, bladder or prostate. Less often the cause is an injury, a blood vessel problem in the kidney, or bleeding after a kidney biopsy or surgery. Blood thinners and bleeding disorders can make bleeding worse or bring it out.

Renal artery embolization blocks a small artery inside the kidney that is bleeding. A thin catheter is passed into an artery, usually at the groin, and guided to the renal artery under live imaging. Dye shows the branch that is bleeding or abnormal.

Tiny particles, coils or other material are then released into that branch to close it. The aim is to treat only the bleeding branch and leave as much of the kidney working as possible.

It is considered for selected arterial causes. These include an injury to the kidney, bleeding after a kidney biopsy or surgery, an abnormal tangle of vessels, a small bulge in an artery wall called a pseudoaneurysm, and a bleeding kidney growth. It is not used for the commonest causes of blood in the urine, such as infection or stones, which are treated differently.

An ultrasound of the kidneys, ureters and bladder is usually the first scan. It can show stones, a blocked kidney, a growth, and clots in the bladder, without radiation or dye. That is useful when the kidneys need protecting from dye.

Colour Doppler adds blood-flow information. It can show an abnormal connection between an artery and a vein, or a small bulge in an artery, which can follow a kidney biopsy or injury. It also shows how well blood flows into the kidney.

These scans cannot always find the exact bleeding point. If bleeding continues or an arterial cause is suspected, a CT scan with dye is usually the next step, because it can show active bleeding and the artery behind it. CT and MRI are not available at the centre. Your doctor advises where to get one, and we can review the images and reports.

Treatment depends on the cause. A urine infection is treated with antibiotics, stones are dealt with by a urologist, and a doctor may change medicines that add to bleeding. Urologists can also look inside the bladder with a camera, called cystoscopy, and treat prostate bleeding. Surgery to remove part or all of the kidney is another option, usually kept for bleeding that cannot otherwise be controlled.

Embolization is useful when the source is an artery and the aim is to keep the kidney, but it carries risks:

• Loss of kidney tissue: the blocked area loses its blood supply, so the kidney may work slightly less. This matters more if kidney function is already low.
• Post-embolization symptoms: pain in the side, fever, nausea and tiredness for some days.
• Dye problems: an allergic reaction, or strain on the kidneys, especially if kidney function is already poor or you are dehydrated or diabetic.
• Treatment reaching the wrong place: material can reach a branch it was not meant to block.
• Puncture site: bruising, bleeding or damage to the artery at the groin.
• Bleeding returning, or infection of the treated area.

No one can promise that the bleeding will stop for good. If it returns, the team and your urologist will talk about the next step.

The urologist or nephrologist treating you decides together with the interventional radiologist. They look at the scans, the amount of blood lost, kidney function and clotting, and whether a safer option exists.

A kidney function panel checks creatinine, which shows how well the kidneys clear dye and waste. A urine test checks for infection. Both are usually done before any dye is used.

Our team reviews your referral, scans and reports first, then confirms whether the procedure is carried out at the centre or elsewhere, and by whom. Heavy bleeding with dizziness or clots is dealt with at a hospital emergency department, not through a booking.