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Abstract：
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, paleness, 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 patients 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, decrease 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 patients. 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 increasing 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 hemorrhage mainly includes intracapsular hemorrhage, cyst rupture, and spontaneous retroperitoneal hemorrhage. In addition, we also recommend an adaptive process for spontaneous kidney hemorrhage of diagnosis and treatment in peritoneal dialysis patients. The significance of these cases lies in the fact that patients 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.
摘要：
自发性肾囊肿出血是腹膜透析（PD）患者的临床急症之一，可能危及生命。主要的抱怨是突然的腰痛，苍白,伴有或不伴有呕吐或发烧的低血压性休克。与遗传性多囊肾病相反,慢性肾脏病继发后天性囊性肾脏病(ACKD)在临床诊治中容易被忽视或延误,导致严重的临床结果。我们报告了北京大学第一医院腹膜透析中心的3例ACKD自发性出血患者。共同的特点如下，长期的透析史,轻度至重度腰痛，血红蛋白减少，负PD解决方案，通过计算机断层扫描（CT）建立的诊断，并在治疗ACKD出血期间继续PD。治疗方法从保守到单侧选择性肾动脉栓塞不等。在这项研究中,在PD患者中调查了ACKD的发病率。共有316名患者接受了腹部超声检查，CT,或磁共振成像（MRI）在过去的1年。其中,103例(32.9%)符合ACKD诊断标准。发病率为27.5%,37.8%,43.8%,59.1%,和88.6%，当透析史范围为≤3、>3&≤5、>5&≤7、>7&≤9、>9年时，分别,呈现增长趋势。大多数ACKD出血可以治愈，治疗后预后可接受。包括休息,输血,选择性肾动脉栓塞术,或者肾切除术.我们总结了风险因素，包括长期的透析史,抗凝或抗血小板，泌尿系统的炎症或结石，但在初始肾脏疾病和性别上没有差异。ACKD出血主要包括囊内出血，囊肿破裂,和自发性腹膜后出血.此外,我们还建议对腹膜透析患者的自发性肾出血进行适应性诊断和治疗.这些病例的意义在于，ACKD患者可能与囊肿出血和恶性肿瘤等并发症有关。因此，腹膜透析医师应高度重视ACKD的监测。
