The complexity of hemorrhage-generating factors in various organs in acute kidney injury.

Bleeding disorders, associated with macroscopic and microscopic lesions in different organs are frequently found in acute kidney injury (AKI), in the third stage of the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification, treated by hemodialysis. The study included 81 cases of AKI of various causes (septic, posttraumatic, postoperative, toxic, medical nephropathies). 59.25% of the patients presented various forms of bleeding disorders (gastrointestinal bleeding, meningo-cerebral hemorrhage, epistaxis, hemodialysis vascular access bleeding, etc.). In the deceased patients that underwent necropsy, various bleeding lesions were found, involving the lungs, kidneys, brain, gastrointestinal tract and liver. A physiopathological interpretation of the factors generating these lesions and their impact on the evolution and prognosis was performed. These factors are related to the AKI's etiology, as well as the physiopathological disorders regarding the uremic syndrome and the various therapies required (blood transfusions, hemodialisys, heparin administration, surgery, macromolecule perfusion). In conclusion, multiple factors are involved in causing bleeding disorders in various organs with a major impact on the evolution and prognosis of AKI patients.