<![CDATA[Renal subcapsular fluid collections may compress the renal parenchyma, impair cortical perfusion, and contribute to secondary hypertension. Evidence guiding management remains limited, particularly where advanced laparoscopic approaches are unavailable. Case 1 was a 26-year-old man with steroid-sensitive nephrotic syndrome, blood pressure of 145/92 mmHg, creatinine of 1.2 mg/dL (estimated glomerular filtration rate, 75 mL/min/1.73 m²), albumin of 2.2 g/dL, and bilateral subcapsular collections measuring 8 cm on the right and 5 cm on the left. Case 2 was a 63-year-old woman with end-stage renal disease secondary to cervical-cancer-related bilateral ureteric obstruction, blood pressure of 160/100 mmHg, blood urea nitrogen of 85 mg/dL, creatinine of 6.8 mg/dL, bilateral non-functioning kidneys, grade II hydronephrosis, and bilateral 6-cm collections. Both patients underwent ultrasound-guided bilateral percutaneous drainage using an 8-Fr pigtail catheter and Seldinger technique under local anesthesia with 160 mg of 2% lidocaine per side. Case 1 yielded 5,000 mL of whitish fluid from the right and 2,500 mL of clear fluid from the left. Case 2 yielded 2,000 mL from each side, with cultures reportedly growing Escherichia coli susceptible to ciprofloxacin. Oral antimicrobial therapy was administered, and prednisone was restarted in Case 1. One-month ultrasonography showed complete resolution without documented re-accumulation. Post-drainage blood pressure was 125/85 mmHg in Case 1 and 142/92 mmHg in Case 2. Serial blood pressure and laboratory assessments were unavailable; fluid biochemical, cytological, and microbiological analyses were not performed. Ultrasound-guided percutaneous drainage may be a feasible, minimally invasive, resource-sparing option for selected renal subcapsular fluid collections. Microbiological evaluation is important when infection is suspected. Further studies should incorporate standardized fluid analysis and objective pre- and post-drainage clinical assessment. Keywords: Subcapsular renal fluid collection, Percutaneous drainage, Ultrasound-guided drainage, Renal compression, Interventional radiology]]>
