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Nefrologia clinica

SPONTANEOUS KIDNEY RUPTURE IN A PATIENT ON CHRONIC HAEMODIALYSIS

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Abstract

The no traumatic spontaneous rupture of the kidney in chronic HD patients, is a rare event. In most cases it is associated with acquired cystic kidney disease or kidney cancer. The majority of renal cancer consist of transitional cell carcinoma. Squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the renal pelvis are highly uncommon tumors and constitute less than 1% of upper urinary tract neoplasms. SCC and AC are known to be associated with chronic renal calculi and infection.

A 62-year-old woman, suffering from diabetes mellitus with coronary artery disease and severe retinopathy, was admitted to the hospital complaining of an acute and sudden flank pain on the left side. She had received right nephrectomy 10 years ago because of bilateral nephrolitiasis. For 2 years she was on maintenance hemodialysis three times a week. From the start of dialysis her history was uneventful. She was totally anuric. She was not receiving oral anticoagulant therapy. At admittance to hospital, CT scan abdomen showed left kidney significantly increased in volume with inhomogeneous structure, presence of large staghorn calculus in the left renal pelvis, other lower calyceal calculi, and massive hematoma in the lower third of the kidney [Figure 1]. Laboratory tests showed Hb: 6.3 gr/d, coagulation and liver function tests in the normal range. An emergency left nephrectomy was performed. Macroscopic finding: left kidney with a size of 16 cm in length, covered by coagula with ruptured renal capsule. On the cross-section analysis thinning of the cortex, cystic dilatation of the collecting system, with several calculi and a copious amount of brownish liquid, large hemorrhagic collection extended to perirenal adipose tissue. On pathological examination: well differentiated squamous cell carcinoma of the renal pelvis, infiltrating the adipose tissue and the parenchyma. Histological grading UICC: G1-pT3 [Fig. 2-4].

The native kidneys, though no longer functioning, suffer from the chronic irritation from kidney stones. Therefore the patients on with long-standing nephrolithiasis should be monitored.

G. Li Cavoli(1), I. Di Lorenzo(2), A. Ferrantelli(1), C. Tortorici(1), L. Bono(1), C. Zagarrigo(1), F. Servllo(1), O. Schillaci(1), A. Tralongo(1), C. Giammarresi(1), M. Coglitore(1), U. Rotolo(1)
((1)Nefrologia E Dialisi Arnas Civico E Di Cristina Palermo , (2)Anatomia Patologica Arnas Civico E Di Cristina Palermo )
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Realizzazione: Tesi S.p.A.

Per assistenza contattare: Claudia Ingrassia, Tesi S.p.A.
0172 476301 — claudia.ingrassia@gruppotesi.com