title: [Acquired hemophilia A developing at bilateral renal bleeding: a case report].
abstract: A 82-year-old woman with asymptomatic gross hematuria was referred to us for a consultation. Computed tomography and magnetic resonance imaging revealed hydronephrosis in the right kidney and retrograde pyelography showed a filling defect in the right renal pelvis. Cystoscopy revealed gross hematuria from right ureteral orifice concomitant with superficial papillary bladder tumor (catheterized urine cytology: positive) (transurethral resection of bladder tumor UC G1 pTa). She was diagnosed with right renal pelvic carcinoma, and we performed a total right nephroureterectomy. Histolopathological findings showed no evidence of malignancy, but extensive hemorrhaging was observed in the subepithelium. There was hematoma in the retoroperitoneum and she suffered from endotoxic shock after the operation. In the post-operative period, she showed complications involving left renal bleeding. She was diagnosed with acquired hemophilia A based on a decline in factor VIII activity, prolonged APTT and the presence of anticoagulant. Although we administered steroids to her, her general condition deteriated and she died of postrenal renal failure 37 days after the operation. To our knowledge, this is the fourth case worldwide and the third case in Japan of acquired hemophilia A discovered by renal bleeding.
authors.affiliation: Department of Urology, National Hospital Organization Kyoto Medical Center.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kato
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masui
authors.forename: Toru
authors.initials: T
authors.lastname: Yoshida
authors.forename: Takahito
authors.initials: T
authors.lastname: Soma
authors.forename: Mutsuki
authors.initials: M
authors.lastname: Mishina
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuno
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okuno
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Terashima
authors.forename: Sachiko
authors.initials: S
authors.lastname: Minamiguchi
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*