Ryuge Akihiro, Yazawa Masahiko, Kitajima Kazuki, Nakazawa Ryuto, Sasaki Hideo, Chikaraishi Tatsuya, Shibagaki Yugo
Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan.
CEN Case Rep. 2018 May;7(1):5-8. doi: 10.1007/s13730-017-0279-9. Epub 2017 Nov 1.
Arteriovenous fistula (AVF) after allograft biopsy occurs in 1.6-8.3% of kidney transplant patients and most cases remain asymptomatic. Here, we report a case of hemorrhagic shock in a kidney transplant recipient following bleeding from an AVF after graft biopsy. Immediate intensive care including angiographic embolization saved the patient and the allograft. A 62-year-old woman with end-stage renal disease caused by diabetic nephropathy underwent ABO-incompatible kidney transplantation. No complications occurred in the early postoperative period. However, serum creatinine levels did not decrease sufficiently and decreased graft diastolic blood flow was noted on ultrasound. Therefore, at 14 days after kidney transplantation, allograft biopsy was performed to elucidate the cause of allograft dysfunction. At 5 days after allograft biopsy, the patient developed hemorrhagic shock caused by bleeding from an AVF in the allograft. We immediately performed angiographic embolization, and her vital signs improved without deterioration in renal function. AVF can cause hemorrhagic shock, and angiographic embolization is effective for treating it.
同种异体肾活检后动静脉瘘（AVF）在1.6%-8.3%的肾移植患者中出现，且大多数病例无症状。在此，我们报告一例肾移植受者在移植肾活检后因AVF出血导致失血性休克的病例。包括血管造影栓塞术在内的即刻重症监护挽救了患者和移植肾。一名62岁因糖尿病肾病导致终末期肾病的女性接受了ABO血型不相容肾移植。术后早期未发生并发症。然而，血清肌酐水平下降不充分，超声检查发现移植肾舒张期血流减少。因此，在肾移植术后14天，进行了移植肾活检以阐明移植肾功能障碍的原因。移植肾活检后5天，患者因移植肾内AVF出血发生失血性休克。我们立即进行了血管造影栓塞术，患者生命体征改善，肾功能未恶化。AVF可导致失血性休克，血管造影栓塞术对其治疗有效。
