Flank Pain, Nausea, Vomiting and Hypotension in a Chronic Hemodialysis Patient with a Spontaneous Perirenal Hemorrhage

Abstract

Decreases in blood pressure develop in response to a wide range of clinical disorders. Various factors have been implicated in the development of hemodialysis-associated hypotension, including an impairment of the compensatory processes, an autonomic dysfunction or cardiac failure. The additional presence of concomitant acute abdomen may result in a diagnostically challenging situation. We herein report our experience with a chronic hemodialysis patient who developed severe hypotension with acute flank pain due to spontaneous bleeding around the kidney. Concerns regarding the management of the disease are also discussed.

Spontaneous intercostal artery bleeding in a hemodialysis patient

“…The fact that the bleeding occurred just after HD in our patient led us to consider that the heparinization therapy administered during HD might play a role in spontaneous bleeding of ICA as well as uremia itself. Similarly, there had been case reports which considered anticoagulation therapy during HD including UFH and low molecular weight heparin as a contributing factor …”

Retroperitoneal Bleeding: An Experience During Prophylactic Anticoagulation in a Patient With Nephrotic Syndrome

“…Retroperitoneal bleeding is a rare clinical entity with variable causes including percutaneous intervention, rupture of any kinds of vasculature, neoplasms, trauma, and cystic kidney or adrenal diseases. 6 , 7 It has also been shown in patients on systemic anticoagulation with warfarin, unfractionated heparin, or low-molecular-weight heparin. 7 – 9 Most anticoagulated patients do not have underlying structural abnormalities, whereas occult vasculopathy and/or arteriosclerosis, anticoagulant-mediated immune microangiopathy, and unrecognized minor trauma in the microcirculation may be involved in some subsets of patients with the disease.…”

Vascular Diseases and Normal Variants

“…As for renovascular lesions, computed tomography angiography, magnetic resonance angiography, and conventional renal arteriography could usually demonstrate these vascular abnormalities. In ESRD patients, acquired cystic kidney disease is the most common cause of spontaneous hemorrhage [ 17 ]. If there are no identifi able causes on CT or subsequent imaging studies, clarifi cation of anticoagulation therapy is necessary.…”