Wunderlich syndrome

Last revised by Ahmad Alomari on 17 Jan 2024

Wunderlich syndrome is a rare condition in which spontaneous non-traumatic renal hemorrhage occurs into the subcapsular and perirenal spaces.

Wunderlich syndrome is clinically characterized by Lenk's triad:

  • acute flank pain
  • flank mass
  • hypovolemic shock


  • F: flank pain (acute)
  • F: flank mass
  • H: hypovolemic shock

Hemorrhage in the perinephric space, often with a primary lesion seen within the kidney, e.g. angiomyolipoma, renal cell carcinoma.

If the hemorrhage is self-limiting and the patient is responsive to fluid resuscitation, the patient can be managed conservatively. Angiographic selective embolization may be pursued in haemodynamically stable patients. In haemodynamically unstable patients, emergent nephrectomy (partial or total) is often required 3.

It is named after the German physician Carl Reinhold August Wunderlich (1815-1877), who published the first case description in 1856, and who is most famously remembered for his pioneering work on clinical thermometry 5,6. The term Wunderlich syndrome was first recorded by Coenen in 1910 6.

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