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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (3): 546-550. doi: 10.19723/j.issn.1671-167X.2024.03.024

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Acquired cystic kidney hemorrhage in peritoneal dialysis patients: A report of three cases

Wanyin HOU,Jie DONG*()   

  1. Department of Nephrology, Peking University First Hospital; Institute of Nephrology, Peking University; Key Lab of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing 100034, China
  • Received:2022-05-30 Online:2024-06-18 Published:2024-06-12
  • Contact: Jie DONG E-mail:jie.dong@bjmu.edu.cn

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Abstract:

Spontaneous renal cyst hemorrhage is one of the clinical emergencies in peritoneal dialysis (PD) patients and is potentially life-threatening. The main complaints are sudden low back pain, paleness, and hypotensive shock with or without vomiting or fever. In contrast to inherited polycystic kidney disease, acquired cystic kidney disease (ACKD) secondary to chronic kidney disease is easily overlooked or delayed in clinical diagnosis and treatment, leading to severe clinical outcomes. We report three patients with spontaneous hemorrhage of ACKD in the peritoneal dialysis center at Peking University First Hospital. The common features are as follows, long history of dialysis, mild to severe low back pain, decrease in hemoglobulin, negative PD solutions, diagnosis established through computed tomography (CT), and continuing PD during treatment of ACKD hemorrhage. Treatments vary from conservative to unilaterally selective renal artery embolization. In this study, ACKD morbidity was investigated in PD patients. A total of 316 patients who had an abdominal ultrasound, CT, or magnetic resonance imaging (MRI) in the past 1 year were enrolled. Among them, 103 cases (32.9%) met the diagnostic criteria of ACKD. The morbidity rates were 27.5%, 37.8%, 43.8%, 59.1%, and 88.6%, when the dialysis history ranged from ≤3, >3 & ≤5, >5 & ≤7, >7 & ≤9, >9 years, respectively, showing a increasing trend. Most ACKD hemorrhages could be healed and got an acceptable prognosis after treatment, including rest, blood transfusion, selective renal artery embolization, or nephrectomy. We summarize the risk factors, including a long history of dialysis, anticoagulation or antiplatelet, and inflammation or stones of the urinary system, but with no difference in initial kidney diseases and gender. ACKD hemorrhage mainly includes intracapsular hemorrhage, cyst rupture, and spontaneous retroperitoneal hemorrhage. In addition, we also recommend an adaptive process for spontaneous kidney hemorrhage of diagnosis and treatment in peritoneal dialysis patients. The significance of these cases lies in the fact that patients with ACKD are potentially associated with complications such as cyst hemorrhage and malignancy. Thus, peritoneal dialysis physicians should place great importance on the surveillance of ACKD.

Key words: Peritoneal dialysis, Acquired cystic kidney disease, Hemorrhage, Therapy

CLC Number: 

  • R459.5

Figure 1

Abdominal CT images of patient 1 The CT scan shows right kidney hematoma(arrows), ascites, subcutaneous swelling of the abdominal wall, left kidney atrophy, multiple cysts in the left kidney, multiple calcifications in both kidneys."

Figure 2

Association between peritoneal dialysis history and the prevalence of ACKD"

Figure 3

Flow chart of diagnosis and treatment for ACKD hemorrhage in peritoneal dialysis patients PD, peritoneal dialysis; BP, blood pressure; Hb, hemoglobin; ACKD, acquired cystic kidney disease."

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