Spontaneous retroperitoneal hemorrhage in dialysis: a presentation of 5 cases and review of the literature

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

“…Chronic HD patients with perirenal bleeding are not exceptional; however, such patients do not necessarily demonstrate a reduced BP (6). This is also the case with subjects who are not treated with renal replacement therapy (7). Therefore, it is necessary to keep in mind that there may be an etiological link between the perirenal bleeding and the hemodynamic instability that can be associated with acute abdominal pain, as described herein.…”

“…Milutinovich et al reported an incidence of 3% for spontaneous retroperitoneal bleeding in patients on chronic HD in their unit more than three decades ago (12). Anecdotal information regarding such cases has continued to accumulate worldwide, including in Japan (7,13,14). Therefore, the precise incidence of spontaneous perirenal bleeding syndrome among patients with ESRD remains to be elucidated.…”

“…Neoplasms such as renal cell carcinoma and angiomyolipoma seem to be a major etiology for spontaneous perirenal bleeding in general population, while arteriovenous malformation, renal artery aneurysms induced by vasculitis, renal infarction and abscesses have also been considered to be implicated in the condition (8,9,(15)(16)(17)(18)(19). On the other hand, acquired cystic kidney disease (ACKD) is regarded as the most frequent underlying cause among subjects with ESRD (7,19). Bleeding based on the presence of cystic lesions may be due to the rupture of unsupported sclerotic vasculature within the cyst wall, which can be accelerated by persistent hypertension (19).…”

“…Bleeding based on the presence of cystic lesions may be due to the rupture of unsupported sclerotic vasculature within the cyst wall, which can be accelerated by persistent hypertension (19). Moreover, the anticoagulation used for the HD treatment, in addition to functional platelet abnormalities, may also act as a contributory factor among such subjects, thereby resulting in perinephric hemorrhage (7,12,20,21). Therefore, the clinical characteristics, including the etiological background of the disease, in subjects with ESRD and those without ESRD may need to be evaluated separately.…”

“…Therefore, the clinical characteristics, including the etiological background of the disease, in subjects with ESRD and those without ESRD may need to be evaluated separately. Indeed, a male predominance has been demonstrated in subjects with ESRD, but not in those without ESRD (7)(8)(9)18), and such a predominance may also be the case in Japanese chronic HD populations (13,14). The reasons for this finding remain to be determined; however, they may be ascribed to the male predominance of ACKD as well as the larger size and more marked progression of the cysts in male subjects (7,22).…”