A 69-year-old woman with a 20-year history of non-affiliated chronic renal failure (CRF), rheumatoid arthritis (RA), under chronic corticosteroid treatment.
The patient begins a sudden clinical picture of total anemizing hematuria, hemodynamic compromise, accompanied by significant deterioration of renal function (creatinine 6.9), after orthotic knee surgery.
Urological ultrasound of the kidneys is normal, with no alterations in the parenchyma or collecting system; a large bladder clot is observed.
After failure of conservative management with washed serum, the patient presented hemodynamic lesions, performing endoscopic examination impossible clot extraction; given the situation it was decided to perform open surgery, bladder opening, extraction of macroscopic mucosal bleeding without bladder appreciation.
Random biopsies of the bladder mucosa were taken and reported as bladder amyloidosis with extensive involvement of vessels.
Corticosteroid infusion and colchicine were administered.
The patient was discharged without hematuria and improvement of renal function (creatinine 2,3).
