A case of colonoscopy-induced Wunderlich's syndrome in a hemodialysis patient: coincidence or association?

Wunderlich syndrome, or spontaneous renal hemorrhage (SRH), is a rare condition encountered in patients undergoing chronic hemodialysis (HD) usually attributed to acquired cystic kidney disease (ACKD) among other causes. In the literature, colonoscopy is associated with splenic injuries, and renal hemorrhage has not been previously described. Management can range from conservative treatment to angiographic embolization or exploration and nephrectomy. Here we report an unusual case of a 54-year-old woman HD patient who presented with SRH within a few days of colonoscopy. The reason of SRH was rupture of an ACKD cyst. We assumed that colonoscopy was a provoking factor and elaborated hypotheses for its etiopathogenesis. The patient underwent successful left nephrectomy. The importance of this case lies in the fact that colonoscopy is not always an innocent procedure in HD patients, and could be complicated by renal cyst hemorrhage.

Exploring comprehensive glycan profiles of acquired cystic kidney disease associated renal cell carcinoma to establish a new diagnostic biomarker

Acquired cystic kidney disease (ACKD) is characterized by the development of numerous renal cysts. Incidence of ACKD is higher amongst patients on haemodialysis and the longer a patient receives this treatment, the more likely ACKD is to occur. Assistant Professor Kunio Kawanishi, Faculty of Medicine, University of Tsukuba, Japan, is focusing on acquired cystic kidney disease associated renal cell carcinoma (ACD-RCC), which is an unique and major type of RCC in haemodialysis patients. He and his team are investigating comprehensive glycan profiles of ACD-RCC to detect possible biomakers. If a useful biomarker can be discovered, disease diagnosis could be improved and therapeutic targets for treatment could be provided. In his current project, Kawanishi is exploring the significance of sialic acid modification and accumulation of ketodeoxynonulosonic acid (Kdn) in end-stage renal disease (ESRD). He is using different techniques to decipher how Kdn and other sialic acids react and circulate within the human body. Kawanishi linked into the TIA collaborative network, which enabled him to access invaluable samples for next generation sequencing, enabling him to determine mRNA expression and perform glycan analysis with lectin microarray. Currently, the researchers are using mass spectrometry to detect ACD-RCC specific glycostructure for establishing ELISA. Next, the team will identify the lectin and antibody specific to the glycan and its carrier protein.

Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: A 20-year single-center experience

Objectives: To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD). Methods: This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed. Results: Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications. Conclusions: Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD. doi: https://doi.org/10.12669/pjms.37.4.3999 How to cite this:Chen CS, Ahn H, Shin JH, Li HL, Kim JW, Ibrahim A, et al. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: A 20-year single-center experience. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3999 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Spontaneous Retroperitoneal Hemorrhage in a Patient with Acquired Cystic Kidney Disease

Spontaneous retroperitoneal hemorrhage (SRH) is a rare emergency. It is usually encountered in patients on hemodialysis and is associated with high rate of morbidity and mortality. This is a case from the emergency department. The patient had unstable vitals with SRH following dialysis. Immediate exploration and nephrectomy using transverse lateral lumbotomy incision were done. Patients on hemodialysis are at a risk of SRH and frequent surveillance is recommended. Acquired cystic kidney disease (ACKD) can develop in hemodialysis patients and put them at risk for bleeding. Transverse lateral lumbotomy may be a safe option for direct access to the kidney in emergency kidney surgery.