William Santis, M.D. Michelle M. McNicholas, M.D. Beth Israel Hospital, Harvard Medical School Boston, Massachusetts

A 61 year-old female with chronic retroperitoneal fibrosis presented with dizziness and gross hematuria shortly after a routine nephrostomy tube change. Her history was significant for colon carcinoma which had been treated by radiation. The therapy was complicated by retroperitoneal fibrosis, for which she has required bilateral internal and external nephrostomy tubes for four years. The most recent nephrostomy change was reportedly difficult, and the patient described persistent gross hematuria with clots per urethra and left nephrostomy since the procedure.

Medications: None

Physical Examination:

1. Thin and pale.
2. Bright red clots in the left nephrostomy bag.

Laboratory:

1. Hematocrit: 25%

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