Dialysis-Associated Acquired Cystic Kidney Disease as a Cause of Progressive Renal Hemorrhage in a Patient Receiving Hemodialysis: A Case Report.

BACKGROUND Acquired cystic kidney disease is a known complication in patients receiving hemodialysis and one cause of spontaneous hemorrhage. Spontaneous hemorrhage of acquired cystic kidney disease in patients receiving hemodialysis was previously described as a rare condition with a poor prognosis. This report describes the case of a 68-year-old man with dialysis-associated acquired cystic kidney disease presenting with spontaneous intracystic hemorrhage. CASE REPORT A 68-year-old man on maintenance hemodialysis for 2 years presented with right lower abdominal and lumbar pain 5 hours after hemodialysis. Physical examination revealed percussion tenderness over the right renal region. The patient had normal coagulation functions and used low-molecular-weight heparin for anticoagulation during hemodialysis. Both the conservative management and artery embolization with digital subtraction angiography were unsuccessful. Dynamic monitoring of hemoglobin concentration indicated a downward trend. Computed tomography of the abdomen revealed progressive enlargement of the hematoma. Subsequently, the patient underwent a right nephrectomy. Postoperative gross pathological finding verified spontaneous hemorrhage caused by rupture of dialysis-associated acquired cystic kidney disease. Postoperatively, the level of hemoglobin remained stable. CONCLUSIONS This case with spontaneous hemorrhage of dialysis-associated acquired cystic kidney disease highlights the need for surveillance in patients receiving hemodialysis. Prompt surgical intervention is beneficial for patients with dialysis-associated acquired cystic kidney disease presenting with spontaneous hemorrhage and a persistent decline of hemoglobin.