Kidney rupture: an unusual and oligosymptomatic complication in a dialysis patient with acquired cystic disease.
Acquired cystic kidney disease (ACKD) is a complication of end-stage renal disease, the prevalence of which is related to dialysis duration; incidence of ACKD and associated conditions (neoplasia, hemorrhage) have decreased with improvements in renal transplantation and with the ageing of the dialysis population. This report regards spontaneous kidney rupture in a 57-year old patient, on home hemodialysis for 11 years, with ACKD for 5 years. At the end of a dialysis session, the patient reported sudden onset of colicky flank pain, followed by macrohematuria. Pain remitted with low doses of pain relievers, leaving dull flank discomfort. The patient self diagnosed a renal colic, and called the hospital two days later. At referral, two large hemorrhagic renal masses (7 and 2.8 cm) were found at ultrasound and CT scan. At surgery, kidney rupture was diagnosed. This case highlights the life threatening complications associated with ACKD, and underlines that massive renal hemorrhage may occur with relatively minor symptoms.
Piccoli
Giorgina Barbara
GB
Department of Internal Medicine, University of Torino, Italy. gbpiccoli@hotmail.com
Bermond
Francesca
F
Mezza
Elisabetta
E
La Saponara
Fedele
F
Quaglia
Marco
M
Gai
Massimo
M
Anania
Patrizia
P
Biancone
Luigi
L
Jeantet
Alberto
A
Ferrando
Ugo
U
Segoloni
Giuseppe Paolo
GP
D005500:Follow-Up Studies; D006437:Hemodialysis, Home / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome