A Rare Case of Massive Postpartum Hematuria and AKI

Introduction: Massive renal haemorrhage in the postpartum period leading to acute kidney injury (AKI) is a rare clinical entity, with few reported cases. It typically occurs without prior coagulopathy or renal disease. The proposed aetiology is the reopening of pyelovenous channels due to pregnancy-induced hydroureteronephrosis. Such haemorrhage is often massive yet self-limiting. Case Description: A postpartum mother (P2L2A1) presented on postpartum day 2 (PPD 2) with gross painless hematuria, bilateral leg swelling, and facial puffiness. Evaluation revealed severe renal dysfunction (Serum Creatinine: 5.8 mg/dL). Autoimmune markers (ANA, complements) were negative, and her coagulation profile was normal. A peripheral smear showed normocytic normochromic anaemia with normal platelets. There was no history of pre-existing renal disease or similar episodes. A plain CT KUB demonstrated hyperintense content (59 HU) with a fluid level in the right pelvicalyceal system and ureter, indicative of haemorrhage (Image 1). The patient was managed conservatively with continuous bladder drainage, Intravenous diuretics and empirical antibiotics. Her hematuria resolved, and renal parameters began improving by PPD 6. Repeat imaging confirmed the absence of further haemorrhage. The bladder catheter was removed, and she was discharged on PPD 10 with normal kidney function. Follow-up after one week showed sustained normal renal function and adequate urine output. Discussion: This case highlights a rare instance of massive postpartum renal haemorrhage causing severe AKI, successfully managed with conservative measures. Clinicians should consider this diagnosis in postpartum patients with unexplained hematuria and AKI, as timely recognition can lead to an excellent prognosis and complete renal recovery.Image 1: Hyperintense content with a fluid level in the right pelvicalyceal system