The spontaneous rupture of contracted kidney with renal hematoma in patients on CAPD : five cases in Inha University kidney center between years 1996 - 2016

초록

Objectives : Spontaneous renal bleeding into the subcapsular or perinephric spaces in a patient on chronic ambulatory peritoneal dialysis (CAPD) is a very rare clinical entity. Because of highly correlated incidence between acquired renal cyst and renal malignancy in dialysis, it should be followed-up with repeated radiologic studies after initial event of renal bleeding. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture (SRR) in long-term peritoneal dialysis patients. Methods : We investigated patients on dialysis who developed spontaneous renal rupture between 1996 and 2016 in CAPD clinic of our institution. Clinical features were analyzed in dialysis patient cohort on CAPD and were retrospectively reviewed by the electronic medical records of patients diagnosed with SRR with radiological studies. Results : The total accumulated number of CAPD enrolled patients were 727. This retrospective study analyzed 5 patients who developed SRR. The number of male was 4. Primary renal disease consisted of chronic glomerulonephritis (n=2), hypertensive nephropathy (n=1), ADPKD (n=1), single kidney due to left nephrectomy (n=1). Presenting symptom was sudden onset of flank pain in all patients. Mean duration from initiation of dialysis to development SRR was 5 years. Abdominal computed tomography and renal angiography showed subcapsular or perinephric hematoma in all patients. 3 patients already had multiple acquired renal cysts. 3 patients were treated with conservative management including blood transfusion, 1 patient was treated with embolization of renal artery, 1 patient was treated on surgical exploration. All 5 patients recovered without recurrence. Pathologic examination demonstrated small sized-renal cell carcinoma in 1 of 5 patients. Conclusions : These cases demonstrates spontaneous renal rupture should be considered in the differential diagnosis of unexplained abdominal or flank pain with sudden dr