Yun Xie1,2, Bo Yang2,3, Gengru Jiang1, Wei Lu1, Claudio Ronco2,4. 1. Department of Nephrology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. 2. International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy. 3. Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China. 4. Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
Abstract
INTRODUCTION: Spontaneous perirenal hemorrhage (SPH) or Wunderlich syndrome, is a rare but potentially life-threatening condition. It is characterized by an unexpected bleeding in the kidneys and usually presents as an abdominal pain. Angiography and more recently selective renal arterial embolization are emerging as effective modalities for the diagnosis and treatment of SPH. In this article, we report a total of three cases of SPH in hemodialysis (HD) patients. METHODS: This is the experience of diagnosis and treatment of SPH in HD patients. FINDINGS: All three were female, between 37 and 54 years of age and were undergoing HD for end stage renal disease (ESRD). Two of patients presented with left flank or abdominal pain after termination of HD therapy, while the third patient presented with left abdominal pain during the dialysis session. All patients received anti-coagulation therapy for HD, but no abnormal levels of coagulation index were found. These patients were diagnosed using CT and two of them were diagnosed with acquired cystic kidney disease (ACKD). Selective renal arterial embolization was performed in the case of active bleeding. DISCUSSION: We are aware that HD patients have elevated risk of bleeding related complications, additionally the presence of an acute abdominal pain increases the suspicion of SPH as a possible cause. ACKD can be considered one of the possible risk factors for SPH in long-term HD patients. Interventional treatment for kidney injury is useful and safe for active bleeding in most cases.
INTRODUCTION: Spontaneous perirenal hemorrhage (SPH) or Wunderlich syndrome, is a rare but potentially life-threatening condition. It is characterized by an unexpected bleeding in the kidneys and usually presents as an abdominal pain. Angiography and more recently selective renal arterial embolization are emerging as effective modalities for the diagnosis and treatment of SPH. In this article, we report a total of three cases of SPH in hemodialysis (HD) patients. METHODS: This is the experience of diagnosis and treatment of SPH in HDpatients. FINDINGS: All three were female, between 37 and 54 years of age and were undergoing HD for end stage renal disease (ESRD). Two of patients presented with left flank or abdominal pain after termination of HD therapy, while the third patient presented with left abdominal pain during the dialysis session. All patients received anti-coagulation therapy for HD, but no abnormal levels of coagulation index were found. These patients were diagnosed using CT and two of them were diagnosed with acquired cystic kidney disease (ACKD). Selective renal arterial embolization was performed in the case of active bleeding. DISCUSSION: We are aware that HDpatients have elevated risk of bleeding related complications, additionally the presence of an acute abdominal pain increases the suspicion of SPH as a possible cause. ACKD can be considered one of the possible risk factors for SPH in long-term HDpatients. Interventional treatment for kidney injury is useful and safe for active bleeding in most cases.
Authors: Cheng Shi Chen; Hyemin Ahn; Ji Hoon Shin; Hai-Liang Li; Jong Woo Kim; Alrashidi Ibrahim; Hee Ho Chu Journal: Pak J Med Sci Date: 2021 Jul-Aug Impact factor: 1.088