Perirenal hemorrhage with contralateral recurrence after repeated massage chair use in a patient receiving hemodialysis

Mechanical massage may be an overlooked exposure in patients presenting with renal hemorrhage. A 53-year-old man with end-stage renal disease receiving hemodialysis experienced perirenal hemorrhage followed nine months later by a second episode in the contralateral kidney. During the first episode, a few hours after a vigorous massage chair session, the patient presented with abdominal pain and a decrease in hemoglobin. Computed tomography (CT) demonstrated a large right perirenal and pararenal hematoma. Right renal artery coil embolization was performed despite no active bleeding on angiography. Nine months later, shortly after another massage session in the same chair, the patient presented again with abdominal pain and a decrease in hemoglobin. This time, CT demonstrated a large left perirenal hematoma with active bleeding, prompting left renal artery embolization. This repeated temporal association adds corroborative evidence to an earlier single report of perirenal hemorrhage after chair massage in a patient with polycystic kidney disease. Cystic abnormalities and possible uremic platelet dysfunction may have increased susceptibility, although causation cannot be established. Targeted questioning about minimal trauma may identify a potentially avoidable exposure.