腹膜透析患者获得性肾囊肿出血3例  

Acquired cystic kidney hemorrhage in peritoneal dialysis patients:A report of three cases

作　　者：侯婉音 董捷[1] HOU Wanyin;DONG Jie(Department of Nephrology,Peking University First Hospital,Institute of Nephrology,Peking University,Key Lab of Renal Disease,Ministry of Health of China,Key Laboratory of CKD Prevention and Treatment,Ministry of Education of China,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾脏内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室,北京100034

出　　处：《北京大学学报（医学版）》2024年第3期546-550,共5页Journal of Peking University:Health Sciences

摘　　要：腹膜透析是终末期肾病患者肾脏替代治疗方式之一,因其简便有效,近年来被应用于越来越多的患者。截止到2017年,全球约有超过27万患者接受腹膜透析,占所有透析患者的11%[1]。我国腹膜透析人群比例近年来也逐渐增加,约为34.99/100万[2]。自发性肾出血常继发于肾肿瘤、结节性多动脉炎肾脏受累及肾囊肿等基础性肾脏病患者[3-4],临床主要表现为突发性腰痛、低血压休克,其中肾囊肿引起的出血是维持性透析患者的临床急症,可使患者被迫中止透析,甚至危及生命。SUMMARY Spontaneous renal cyst hemorrhage is one of the clinical emergencies in peritoneal dialysis(PD)patients and is potentially life-threatening.The main complaints are sudden low back pain,paleness,and hypotensive shock with or without vomiting or fever.In contrast to inherited polycystic kidney disease,acquired cystic kidney disease(ACKD)secondary to chronic kidney disease is easily overlooked or delayed in clinical diagnosis and treatment,leading to severe clinical outcomes.We report three patients with spontaneous hemorrhage of ACKD in the peritoneal dialysis center at Peking University First Hospital.The common features are as follows,long history of dialysis,mild to severe low back pain,decrease in hemoglobulin,negative PD solutions,diagnosis established through computed tomography(CT),and continuing PD during treatment of ACKD hemorrhage.Treatments vary from conservative to unilaterally selective renal artery embolization.In this study,ACKD morbidity was investigated in PD patients.A total of 316 patients who had an abdominal ultrasound,CT,or magnetic resonance imaging(MRI)in the past 1 year were enrolled.Among them,103 cases(32.9%)met the diagnostic criteria of ACKD.The morbidity rates were 27.5%,37.8%,43.8%,59.1%,and 88.6%,when the dialysis history ranged from≤3,>3&≤5,>5&≤7,>7&≤9,>9 years,respectively,showing a increasing trend.Most ACKD hemorrhages could be healed and got an acceptable prognosis after treatment,including rest,blood transfusion,selective renal artery embolization,or nephrectomy.We summarize the risk factors,including a long history of dialysis,anticoagulation or antiplatelet,and inflammation or stones of the urinary system,but with no difference in initial kidney diseases and gender.ACKD hemorrhage mainly includes intracapsular hemorrhage,cyst rupture,and spontaneous retroperitoneal hemorrhage.In addition,we also recommend an adaptive process for spontaneous kidney hemorrhage of diagnosis and treatment in peritoneal dialysis patients.The significance of these cases lies in the

关 键 词：腹膜透析 获得性肾囊肿 出血 治疗 

分 类 号：R459.5[医药卫生—治疗学]