Unusual causes of Hematuria in dialysis patients: Diagnostic dilemma, risks and management
A 50-year-old male with ESRD, on hemodialysis since 14 months, awaiting renal transplantation presented with complaints of progressively increasing acute left flank pain, and was referred to the emergency from another centre. During evaluation for the cause of chronic kidney disease, bilateral shrunken kidneys were noted. No biopsy was performed and patient was declared ESRD and initiated on maintenance HD. There was no history of hematuria. This patient was hypertensive and diabetic for more than 10 years. Hemoglobin fell by 4 g% inspite of 6 units of blood transfusion. He presented to the emergency department with features of shock. On evaluation, patient was pale with a blood pressure of 86/60mm of Hg. Platelet count was 2.85/μL and coagulation parameters were normal. After fluid resuscitation and stabilization, CT scan revealed large perirenal hematoma with compressed atrophic kidney []. Pain and lump gradually increased with progressive fall in hemoglobin, which led to exploration and nephrectomy with removal of perirenal hematoma. Operative finding revealed a large perirenal hematoma with atrophic kidney []. On gross examination of the specimen, outer surface showed scars and focal areas of granularity. On cut-section cortico-medullary junction was indisntinct and PCS was filled with blood clots. Section of the kidney examined showed globally and focally sclerosed glomeruli with atrophic tubules. Interstitium was studded with lymphocytic infiltrates at places. No ulceration or granulomas were noted.