Abstract
We report herein two cases of colitis associated with chronic renal failure. One case had ischemic colitis (IC), the other ulcerative colitis (UC).
A 28-year-old female with a history of diabetes mellitus, hypertension, congestive heart failure, constipation and chronic renal failure developed IC. She was admitted to our department because of bloody diarrhea with severe abdominal pain that was recognized several minutes after initiating hemodialysis. Barium enema examination revealed segmental narrowing in the left colon. Colonoscopy showed a longitudinal ulcer in the same portion. These findings were considered typical of IC. It is generally said that IC most often affects the elderly because of the greater frequency of vascular disease in that group, but IC may affect younger hemodialysis patients because of the numerous risk factors for IC, such as arteriosclerosis due to secondary hyper-parathyroidism, hyper-intraintestinal pressure based on uremic autonomic nervous disorder inducing hypokinetic intestinal movement, and decreased micro-circulation in the colon induced by the above factors. Therefore, we must consider the possibility of IC in hemodialysis patients with vascular disease associated with rectal bleeding, even when the patient is young. In the second case, a 32-year-old male was admitted because of abdominal pain and melena with fever. Colonography revealed serrations along the contour of the transverse and descending colon. Endoscopic examination revealed diffuse erythema, friability of the mucosa and multiple ulcers occurring from the middle portion of the transverse colon to the descending colon. A biopsy specimen from the descending colon showed mucosal inflammation and crypt abscess. These findings indicated UC. While the cause of UC remains unknown, immunologic and psychological factors have been suggested in several reports. In our case, the CD4/CD8 ratio was normal, and UC developed during the patient's busiest season. Therefore, psychogenic factors may be related to the etiology in this case. UC is very rare among hemodialysis patients, but the possibility of UC must be considered in cases of chronic renal failure complicated with bloody diarrhea.
