腹膜透析患者获得性肾囊肿出血3例OA北大核心CSTPCD

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,pale-ness,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 pa-tients 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,de-crease 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 pa-tients.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 in-creasing 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 hemor-rhage mainly includes intracapsular hemorrhage,cyst rupture,and spontaneous retroperitoneal hemor-rhage.In addition,we also recommend an adaptive process for spontaneous kidney hemorrhage of diagno-sis and treatment in peritoneal dialysis patients.The significance of these cases lies in the fact that pa-tients with ACKD are potentially associated with complications such as cyst hemorrhage and malignancy.Thus,peritoneal dialysis physicians should place great importance on the surveillance of ACKD.