Spontaneous Renal Rupture in Patients on Chronic Hemodialysis / 대한신장학회잡지

BACKGROUND: Because of high incidence of acquired renal cyst and renal malignancy, it is suggested that spontaneous renal rupture more frequently occurs in patients receiving long-term hemodialysis than general population. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture in hemodialysis patients. METHODS: This retrospective study enrolled 12 hemodialysis patients who developed spontaneous renal rupture. We investigated primary renal disease, duration of dialysis, clinical symptoms and signs, radiologic findings, treatment modalities, and histologic findings. RESULTS: The mean age of the patients was 54+/-10 years old and the number of male was 9. Primary renal disease consisted of autosomal dominant polycystic kidney disease (PCKD) (n=5), chronic glomerulonephritis (n=2), diabetic nephropathy (n=1), hypertensive nephropathy (n=1), unknown cause (n=3). Presenting symptoms and signs were sudden onset of flank pain in 9 patients and gross hematuria with mild flank pain in 3 patients. Mean duration from initiation of hemodialysis to development of spontaneous renal rupture was 53+/-36 months. Abdominal computed tomography showed subcapsular or perinephric hematoma in all patients. Of the 7 non-PCKD patients, 6 patients had multiple acquired renal cysts. Surgical exploration was undertaken in 9 patients. Pathologic examination demonstrated small sized-renal cell carcinoma in 2 of 9 patients. Three patients were only treated with conservative management including blood transfusion. All 12 patients recovered without recurrence. CONCLUSION: This study demonstrated that genetic or acquired renal cyst was an important cause of spontaneous renal rupture in hemodialysis patients and presenting manifestations were sudden onset of flank pain and gross hematuria.

A Case of Epidural Abscess in Hemodialysis Patient Complaining of Fever and Back Pain / 대한신장학회잡지

pidural abscess in hemodialysis patient is uncommon diseases, but it causes severe neruological complication if diagnois is delayed. In the clinical practice, diagnosis of epidural abscess is often delayed because it is difficult to differentiate epidural abscess with simple back pain. Therefore, it is important to make early diagnosis and treatment of epidural abscess to prevent neurological sequellae. We here report a case of epidural abscess with early diagnosis and successful treatment. A 54-year-old male patient was admitted to back pain and fever. Under the presumptive diagnosis of epidural abscess, MRI was performed, and it revealed epidural abscess. Intravenous antibiotic treatment was started and drain of abscess was subsequently performed since back pain was persisted. He discharged without neurologic sequellae. Our case strongly suggests that epidural abscess should be considered in patients and early radiologic evaluation and treatment are mandatory to prevent neurological complication.