Spontaneous Bilateral Renal Rupture in an End-stage Renal Disease Patient Treated with Hemodialysis.
- Author:
Sarah CHUNG
1
;
Dae Eun CHOI
;
Ki Ryang NA
;
Chong Koo SUL
;
Kang Wook LEE
;
Young Tai SHIN
Author Information
1. Division of Nephrology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. ytshin@cnu.ac.kr
- Publication Type:Case Report
- Keywords:
Cystic kidney disease;
Spontaneous rupture;
Hemodialysis
- MeSH:
Addison Disease;
Adrenocorticotropic Hormone;
Carcinoma, Renal Cell;
Flank Pain;
Fludrocortisone;
Hematoma;
Hemorrhage;
Humans;
Hypotension, Orthostatic;
Kidney;
Kidney Diseases, Cystic;
Kidney Failure, Chronic;
Middle Aged;
Myocardial Infarction;
Nephrectomy;
Plasma;
Prednisolone;
Renal Dialysis;
Rupture;
Rupture, Spontaneous
- From:Korean Journal of Nephrology
2010;29(5):670-674
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Bilateral spontaneous renal rupture is a rare event that has been documented in only a few reports. We report a spontaneous, but not simultaneous rupture of both kidneys in a 64-year-old man with end-stage renal disease who had been treated with hemodialysis for 78 months. He complained of sudden left flank pain. Abdominal computed tomography (CT) revealed a huge perirenal hematoma with multiple renal cysts. The patient underwent an urgent left nephrectomy and was diagnosed as multiple acquired renal cysts with rupture and focal incidental papillary renal cell carcinoma. Twenty-two days after the left nephrectomy, he complained of sudden right flank pain and abdominal CT showed another massive perirenal hematoma. The patient underwent a right nephrectomy and was diagnosed as renal cyst rupture with perirenal hemorrhage. However, there was no evidence of renal cell carcinoma in the right kidney. Postural hypotension and frequent hypotensive episodes developed during hemodialysis several months after both nephrectomies. He was diagnosed as primary adrenal insufficiency with rapid adrenocorticotropic hormone (ACTH) stimulation test and the level of plasma ACTH and was treated with prednisolone and fludrocortisone. The patient died of acute myocardial infarction 32 months after bilateral nephrectomies.
