Male 45yrs, HBV and D viral cirrhosis following antiviral treatment, listed for LT. Chronic hematuria and anemia since at least one year with need of chronic transfusion. Portal cavernoma associated with trombophylia (homozygous for PAI 1 mutation). No treatment ( platelets 20.000 and INR 2 )
All exams and imaging found no renal disease, cystoscopy only saw mild bilateral blood from both sides . Cryoglobulins are negative.
Yes really, especially with a deep thrombopenia and alterations in the coagulation parameters
Hello.
This is a really severe case. I think that the hematuria is due to thrombocytopenia. At the same time the thrombocytopenia may be: - a sign of co-infection (HBV+HDV), second - a complication of interferon therapy, third - may develop because of hypersplenism in portal hypertension. Biopsy kidney in this situation is dangerous because the risk of bleeding complications may be higher ( platelets 20.000).
Sincerely, Zmicer.
The most acceptable cause of hematuria is severe thrombocytopenia , no need for kidney biopsy.
Thanks for your suggestions. Thrombocytopenia could be a reason although we frequently see patients with splenomegaly and thrombocytopenia but hematuria is rare. In this case we have no treatment and we can only wait for LT .
usually no manifestations of bleeding tendency in cirrhotic patients due to thrombocytopenia because the megakarocytes although reduced in NO. but their function is within normal , but the level of 20000 is critical, so bleeding can occur.
Have you looked into using a thrombopoietin receptor agonist? They have been shown to help some patients experiencing thrombocytopenia and associated hematologic aberrations during chronic liver disease (such as Hepatitis viruses).
I've attached a recent review of the pharmacotherapeutic options available. Hopefully it helps.
The best way is MDCT perfusion. We could evaluate not only the kidneys structure but also the tissue perfusion and small vessels.
yes portal hypertension is a rare cause of hematuria from variceal bleeding either from the bladder or from vas deferns. However blood seen coming from both kidneys rule this out