A case of retroperitoneal hematoma by spontaneous rupture of renal capsule in hemorrhagic fever with renal syndrome presented with anuria and unilateral flank pain / 대한내과학회지

The hemorrhage in hemorrhagic fever with renal syndrome (HFRS) varies from transient petechial lesions to fulminant and massive bleeding. Also in vital organ such as lung, kidney, spleen, brain and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. We report a case of retroperitoneal hematoma by spontaneous rupture of renal capsule in HFRS presented with anuria and right flank pain. A 34-year-old male was admitted to our hospital presenting anuria and right flank pain for 3 days. He also had suffered from fever and myalgia since 5 days ago. Sonography and computed tomography were performed at the day of hospitalization and showed massive perirenal hematoma with ruptured renal capsule and spurtting subcapsular renal artery on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion and transfusion. After conservative treatment, he recovered from HFRS without further blood loss.

A Case of Spontaneous Hemothorax in a Maintenance Hemodialysis Patient / 대한신장학회잡지

The 55 years old male patient, undergoing maintenance hemodialysis, was admitted on our department because of painful swelling on left knee joint. At 19th hospital day, he complained of severe dyspnea. He had a large amount of pleural effusion of the left chest that was shown to be hemothorax by thoracentesis. After closed thoracostomy, about amount of 3,000 mL of blood was drained and bleeding was sustained from pleural cavity, and then emergency thoracotomy was done. We cannot find any bleeding focus in thoracic cavity, but oozing blood was seen on entire inner thoracic cavity. He had no previous invasive procedure or history of trauma before 6 months. We think that hemothorax may be developed because of defected coagulopathy and increased bleeding tendency due to platelet dysfunction in renal failure patient. Immediately thoracotomy and cryoprecipitate were helpful for this patient. We report a rare case of spontaneous hemothorax in a maintenance hemodialysis patient with literature review.

A case of minimal change glomerulopathy without interstitial nephritis induced by non-opiate analgesics / 대한내과학회지

The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.

A Case of Gastric Mucormycosis, Vascular Invasive Type Associated with a Severe Malnutrition in a Non-diabetic Hemodialysis Patient / 대한신장학회잡지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.

A Case of Gastric Mucormycosis, Vascular Invasive Type Associated with a Severe Malnutrition in a Non-diabetic Hemodialysis Patient / 대한신장학회잡지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.