Hirohama Daigoro, Miyakawa Hiroshi
Division of Nephrology, Showa General Hospital, 2-450 Tenjincho, Kodaira, Tokyo 187-8510, Japan.
Case Rep Nephrol. 2012;2012:178426. doi: 10.1155/2012/178426. Epub 2012 Sep 16.
Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics.
获得性肾囊肿病（ACKD）是慢性肾病一种广为人知的晚期并发症。囊肿在透析过程中往往会随时间增长，并可能导致恶性转化，而肾内或肾周出血是ACKD一种罕见的并发症。在此，我们描述一例44岁男性ACKD患者发生双侧自发性肾周出血的病例，该患者已接受血液透析15年。一次出血是由于囊肿破裂，另一次是由于动脉瘤破裂，两者均通过经导管动脉栓塞术得到控制。在第二次破裂时的肾动脉造影中，我们显示右肾动脉周边存在一个动脉瘤有造影剂外渗。此前有几例自发性肾周出血病例报道，但临床资料有限，而且双侧病例极为罕见。此外，据我们所知，这是首例关于ACKD患者因肾实质内肾动脉动脉瘤破裂导致自发性肾周出血的报告。我们报告此病例是因其罕见性以及对于透析患者并发症的重要性，回顾已报道的双侧病例，并讨论一些临床特征。
