Spontaneous kidney rupture: cases report

Introduction. Spontaneous non-neoplastic renal rupture (Wunderlich syndrome) is a rare and diagnostically challenging urological emergency that is established only after thorough exclusion of neoplastic etiologies.
Objective. To analyze diagnostic features and management strategies for spontaneous non-neoplastic renal rupture (Wunderlich syndrome) based on our institutional experience and a review of the literature.
Materials & methods. We present two clinical cases. Patient 1, a 58-year-old man, was admitted with acute left flank pain and nausea. Ultrasonography (US) and computed tomography (CT) revealed spontaneous rupture of the left kidney with signs of ongoing hemorrhage and a perinephric hematoma. Patient 2, a 59-year-old man, was hospitalized with severe left flank pain and weakness following minimal physical exertion. Imaging (US and CT) demonstrated extensive subcapsular and perinephric hematoma.
Results. In both cases, the diagnosis was confirmed by contrast-enhanced CT, which enabled verification of the rupture, assessment of blood loss, and exclusion of overt neoplasm. Despite an initial attempt at conservative management in the second patient, both ultimately required surgical intervention due to signs of ongoing or recurrent bleeding. Successful organ-preserving surgery was performed in both cases: partial nephrectomy with defect closure. Histopathological examination did not reveal tumor growth.
Conclusion. These cases highlight that spontaneous renal rupture necessitates a comprehensive diagnostic approach with mandatory contrast-enhanced CT. Management should be individualized, stepwise, and guided by multidisciplinary decision-making. Priority is given to conservative measures and endovascular techniques (angiographic embolization). Open organ-preserving surgery remains the treatment of choice when conservative therapy fails or bleeding progresses, allowing avoidance of nephrectomy and preservation of renal function.

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