Korean Journal of Nephrology 2010;29(5):670-674.
Spontaneous Bilateral Renal Rupture in an End-stage Renal Disease Patient Treated with Hemodialysis
Sarah Chung, M.D.1, Dae Eun Choi, M.D.1, Ki-Ryang Na, M.D.1, Chong Koo Sul, M.D.2, Kang Wook Lee, M.D.1 and Young-Tai Shin, M.D.1
Division of Nephrology, Department of Internal Medicine1 and Urology2
College of Medicine, Chungnam National University, Daejeon, Korea
증례 : 혈액투석 중인 말기신부전 환자에서 발생한 양측 신장의 자발성 파열
정사라1, 최대은1, 나기량1, 설종구2, 이강욱1, 신영태1
충남대학교 의과대학 내과학교실1 , 비뇨기과학교실2
Bilateral spontaneous renal rupture is a rare event that has been documented in only a few reports. We report a spontaneous, but not simultaneous rupture of both kidneys in a 64-year-old man with end-stage renal disease who had been treated with hemodialysis for 78 months. He complained of sudden left flank pain. Abdominal computed tomography (CT) revealed a huge perirenal hematoma with multiple renal cysts. The patient underwent an urgent left nephrectomy and was diagnosed as multiple acquired renal cysts with rupture and focal incidental papillary renal cell carcinoma. Twentytwo days after the left nephrectomy, he complained of sudden right flank pain and abdominal CT showed another massive perirenal hematoma. The patient underwent a right nephrectomy and was diagnosed as renal cyst rupture with perirenal hemorrhage. However, there was no evidence of renal cell carcinoma in the right kidney. Postural hypotension and frequent hypotensive episodes developed during hemodialysis several months after both nephrectomies. He was diagnosed as primary adrenal insufficiency with rapid adrenocorticotropic hormone (ACTH) stimulation test and the level of plasma ACTH and was treated with prednisolone and fludrocortisone. The patient died of acute myocardial infarction 32 months after bilateral nephrectomies.
Key Words: Cystic kidney disease, Spontaneous rupture, Hemodialysis

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