Department of Internal Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-Ku, Osaka, 559-0012, Japan.
J Med Case Rep. 2023 Mar 9;17(1):87. doi: 10.1186/s13256-023-03823-2.
Absolute polycythemia can be primary or secondary. Erythropoietin-producing diseases (for example, hypoxia) are the major cause of secondary polycythemia. There are reports of polycythemia secondary to hydronephrosis. However, to our knowledge, there is no report on polycythemia secondary to hydronephrosis due to a urinary stone. Herein, we present a case of polycythemia with an elevated erythropoietin level in a patient with a urinary stone and unilateral hydronephrosis.
A 57-year-old Japanese man presented with polycythemia and an elevated erythropoietin level. Erythropoietin accumulation was not due to erythropoietin secretion by a tumor as no obvious lesions were detected on contrast-enhanced computed tomography. Abdominal ultrasonography revealed a stone in the left urinary tract and renal hydronephrosis, and 2 weeks later, the patient underwent transurethral ureterolithotripsy without complications. Blood tests 2 weeks after transurethral ureterolithotripsy showed that the erythropoietin level had declined. Hemoglobin concentration decreased from 20.8 mg/dL before and immediately after transurethral ureterolithotripsy to 15.8 mg/dL 3 months after transurethral ureterolithotripsy. This case was diagnosed as erythropoietin elevation due to unilateral hydronephrosis with a urinary stone, resulting in polycythemia.
Hydronephrosis is a common disease but is not often associated with polycythemia. Further studies are required to elucidate the mechanism and implications of elevated erythropoietin production in hydronephrosis.
真性红细胞增多症可分为原发性或继发性。促红细胞生成素产生疾病（例如，缺氧）是继发性红细胞增多症的主要原因。有报道称肾积水可引起继发性红细胞增多症。然而，据我们所知，尚无由于尿路结石引起单侧肾积水继发红细胞增多症的报道。在此，我们报告了一例因尿路结石和单侧肾积水导致红细胞生成素水平升高的红细胞增多症患者的病例。
一名 57 岁日本男性因红细胞增多症和红细胞生成素水平升高就诊。红细胞生成素的积累不是由于肿瘤分泌的红细胞生成素引起的，因为在增强 CT 上没有发现明显的病变。腹部超声检查显示左尿路结石和肾积水，2 周后，患者行经尿道输尿管镜碎石术，无并发症发生。经尿道输尿管镜碎石术后 2 周的血液检查显示，红细胞生成素水平下降。血红蛋白浓度从经尿道输尿管镜碎石术前后的 20.8mg/dL 降至经尿道输尿管镜碎石术后 3 个月的 15.8mg/dL。该病例被诊断为由于单侧肾积水合并尿路结石导致的红细胞生成素升高引起的红细胞增多症。
肾积水是一种常见疾病，但通常与红细胞增多症无关。需要进一步研究阐明肾积水时红细胞生成素产生增加的机制和意义。
