Abstract
We report a hemodialysis (HD) patient complicated by severe thrombocytopenia that was improved by bilateral nephrectomy. A 49-year-old man had been on maintenance HD because of chronic renal failure due to autosomal dominant polycystic kidney disease. He had developed drug-induced Aplastic anemia (AA) during the induction phase of HD and had required frequent blood transfusions. However, thrombocytopenia and bleeding tendency persisted, and after a large quantity of blood transfusions, he developed hemochromatosis. It was considered that repeated hemorrhage from multiple renal cysts into the pyelocalyceal system was causing consumptive coagulopathy, therefore bilateral nephretomy was performed. The spleen was removed on the assumption that intrasplenic destruction might contribute to thrombocytopenia concomitantly. As expected, the platelet count was markedly and the abnormality in the blood coagulation system was improved shortly after surgery. Furthermore, we punctured renal cysts in the resected kidneys to clarify hemorrhage and to investigate the blood coagulation system in renal cysts using ultrasonography. The fluid from these cysts was bloody, and D-dimer and thrombin-antithrombin complex were increased in these cysts, suggesting that the blood coagulation system was activated in the multiple renal cysts. To our knowledge, this is the first report to describe the evident efficacy of nephrectomy on thrombocytopenia in a patient with ADPKD and to investigate the blood coagulation system within renal cysts.
