Bilateral spontaneous kidney rupture in a patient with polyarteritis nodosa disguising as granulomatosis with polyangiitis

Renal ruptures are mostly the result of trauma and rarely occur spontaneously.Bilateral nontraumatic renal ruptures are exceptionally rare [1].We present a case of 58-years-old man with long history of smoking, chronic obstructive pulmonary disease and lung tuberculosis who was admitted to the hospital due to persistent fever, night sweats, nasal congestion and cough that were unresponsive to oral antibiotics.Radiological diagnostics revealed sinusitis alongside advanced interstitial lung infiltrates with honeycombing, fibrosis and cavitary lesions.Laboratory findings were notable for high inflammatory markers with positive urine and blood cultures.No skin abnormalities were found upon examination.Broad spectrum intravenous antibiotics were implemented, with only partial response.Six days later the patient was transferred to the nephrology department due to rapid loss of kidney function and overhydration requiring hemodialysis, accompanying moderate proteinuria (ACR 44mg/g; N