以发热为主要症状的自发性肾出血继发感染1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.09.009

摘要/Abstract

摘要：

目的总结以发热为主要症状的自发性肾出血(spontaneous perirenal hemorrhage,SPH)有效鉴别诊断及治疗方法。方法回顾性分析1例不典型症状为首发表现的SPH的临床资料,并结合文献进行讨论。结果患者老年男性,以“发热10 d,血肌酐升高1周”入院。无外伤及手术史,临床表现仅为高热,无腰痛、腹痛、休克等症状,结合实验室及影像学检查,诊断为SPH。经超声引导下穿刺引流及抗感染治疗,患者体温恢复正常。结论临床医生有必要充分了解SPH不典型症状,以期为临床诊治此类疾病提供依据和经验。

关键词: 发热, 自发性肾出血, 阿司匹林, 感染

Abstract:

Objective To summarize the effective differential diagnosis and treatment of spontaneous perirenal hemorrhage (SPH) with fever as the main symptom. Methods The clinical data of a case of SPH with atypical first manifestations were retrospectively analyzed. Relevant literatures were reviewed as well. Results An elderly male patient was admitted for 10-day fever and 1-week elevation of blood creatinine. He denied trauma and surgery history. Fever was the only clinical manifestation, and lumbar pain, abdominal pain and shock were absent. After laboratory testing and imaging examination, the patient was diagnosed as SPH. Body temperature returned normal after ultrasound-guided puncture drainage and anti-infectious therapy. Conclusion It is necessary for clinicians to master atypical manifestations of SPH, so as to provide references and clinical experiences.

Key words: fever, spontaneous perirenal hemorrhage, aspirin, infections

中图分类号:

R692.9

刘岩, 刘琼, 梁晓梅, 刘冰. 以发热为主要症状的自发性肾出血继发感染1例并文献复习[J]. 临床荟萃, 2023, 38(9): 823-826.

Liu Yan, Liu Qiong, Liang Xiaomei, Liu Bing. Secondary infection of spontaneous perirenal hemorrhage with fever as the main symptom: A case report and literature review[J]. Clinical Focus, 2023, 38(9): 823-826.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.009

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/823

图/表 1

图1 双肾增强CT(截状面及冠状面) 注:双肾位置未见异常。右肾体积增大,期内可见多发不规则稍高密度影及低密度影,边界欠清,增强扫描未见明显强化;左肾形态不规则,局部凹陷。橙色箭头处为肾脏血肿

Fig. 1 Enhanced CT of the patient's both kidneys (truncated and coronal planes) The position of both kidneys was not abnormal. The right kidney was enlarged, with multiple irregular slightly dense shadows and low-density shadows with poorly defined borders visible within the period, and no significant enhancement was seen on the enhancement scan. The left kidney has an irregular morphology and is locally depressed. The orange arrow is the renal hematoma

参考文献 20

[1]	Jignesh NS, Darshan G, Srinivasa RP, et al. Wunderlich syndrome: Comprehensive review of diagnosis and management[J]. Radiographics, 2023, 43(6): e220172.
[2]	Tanweer B, Ahmad Z, Iftikhar AK, et al. Wunderlich syndrome with spontaneous renal hemorrhage into renal angiomyolipoma[J]. Urol Ann, 2020, 12(4): 392. doi: 10.4103/UA.UA_169_19 pmid: 33776340
[3]	Ferry S, Richardo RH. Spontaneous perirenal hemorrhage due to ruptured renal arteriovenous malformation: A case report[J]. Urol Case Rep, 2020, 33:101359.
[4]	Masato K, Hidehiro T, Yukihito H. Spontaneous renal hemorrhage in acquired cystic kidney disease[J]. J Gen Fam Med, 2021, 22(2): 94-95. doi: 10.1002/jgf2.400 pmid: 33717784
[5]	Elbaset MA, Mohamad HZ, Ramy El-Ba, et al. Spontaneous renal hemorrhage: critical analysis of different lines of management in non-traumatic patients: A single tertiary center experience[J]. Int Urol Nephrol, 2020, 52(3): 423-429. doi: 10.1007/s11255-019-02333-9 pmid: 31686280
[6]	Yamamoto K, Yasunaga Y. Antiplatelet therapy and spontaneous perirenal hematoma[J]. Int J Urol, 2005, 12(4): 398-400. pmid: 15948729
[7]	陈晓霞, 陈建军, 赵峰. 血透患者自发性肾周出血病例报道3例[J]. 南京医科大学学报:自然科学版, 2021, 41(12): 1865-1868.
[8]	陈利佳, 臧丽, 王少清. 腹膜透析联合血液透析患者自发性肾出血1例[J]. 中国中西医结合肾病杂志, 2021, 22(6): 548-549,565.
[9]	Junichi I, Morgan EG, Rakhi PN, et al. Chronic kidney disease and risk for gastrointestinal bleeding in the community: The atherosclerosis risk in communities (ARIC) study[J]. Clin J Am Soc Nephrol, 2016, 11(10): 1735-1743. doi: 10.2215/CJN.02170216 URL
[10]	George VR, Ghassan D, Stephen H, et al. Recurrent spontaneous hemorrhage in end-stage renal disease[J]. Clini Nephrol, 2019, 91(6): 389-391.
[11]	Zhang CG, Duan M, Zhang XY, et al. Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report[J]. World J Clin Cases, 2021, 9(11): 2602-2610. doi: 10.12998/wjcc.v9.i11.2602 URL
[12]	Adil K, Joshua M, Laura B. Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban[J]. Am J Emerg Med, 2020, 38(5): 1046.
[13]	何礼贤. 发热性疾病诊断的实践和思考[J]. 诊断学理论与实践, 2016, 15(5):540-543.
[14]	周靖轩, 袁春玲, 向晨焱, 等. 尿路致病性大肠杆菌与宿主相互作用的研究进展[J]. 中国免疫学杂志, 2023, 39(1): 189-194.
[15]	Joseph B, Marthe KC, Vivian L, et al. A nested cohort 5-year canadian surveillance of gram-negative antimicrobial resistance for optimized antimicrobial therapy[J]. Sci Rep, 2023, 13(1):14142. doi: 10.1038/s41598-023-40012-z pmid: 37644048
[16]	Thomas A, Isabel H, Tobias DZ, et al. Fusion imaging of contrast-enhanced ultrasound with CT or MRI for kidney lesions[J]. In vivo (Athens), 2019, 33(1): 203-208.
[17]	Chamarthi G, Koratala A. Wunderlich syndrome: Wonder what it is[J]. Clin Case Rep, 2018, 6(9):1901-1902. doi: 10.1002/ccr3.2018.6.issue-9 URL
[18]	Jong WK, Jung YK, Sun TA, et al. Spontaneous perirenal hemorrhage (wunderlich syndrome): An analysis of 28 cases[J]. Am J Emergy Med, 2019, 37(1): 45-47.
[19]	Thomas A, Matthew JR, Anojan N, et al. Changing etiology and management patterns for spontaneous renal hemorrhage: A systematic review of contemporary series[J]. Int Urol Nephrol, 2017, 49(11): 1897-1905. doi: 10.1007/s11255-017-1694-8 pmid: 28871505
[20]	杨晓东, 刘强, 彭玉萍. 肾动脉栓塞术治疗不同原因肾出血的临床效果分析[J]. 中国临床医学影像杂志, 2022, 33(6): 441-445.