Essential Renal Bleeding Presenting as Persistent Unilateral Hematuria Successfully Treated With Factor <scp>XIII</scp> Replacement Therapy: A Case Report

Introduction: Essential renal bleeding is rare and lacks standardized treatment; organ-preserving options are critical in older patients with impaired renal function. Case Presentation: A woman in her early 80s with atrial fibrillation treated with edoxaban, chronic heart failure, and advanced chronic kidney disease presented with gross hematuria and bladder tamponade. Bleeding was localized to the right renal pelvis and ureter, with no tumor, urolithiasis, vascular malformation, or glomerular disease; essential renal bleeding was diagnosed. Hematuria persisted despite edoxaban discontinuation, red blood cell and plasma transfusions, and carbazochrome sodium sulfonate administration. Isolated factor XIII activity was 22%. Intravenous plasma-derived factor XIII concentrate achieved sustained hemostasis, renal function remained stable, and reduced-dose edoxaban was safely resumed. Hematuria did not recur within 24 months. Conclusion: In this population, factor XIII deficiency may contribute to persistent unilateral hematuria despite normal conventional coagulation tests.