Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention?
Wunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high index of suspicion, since i...
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| Format: | Article |
| Language: | English |
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Publicações Ciência e Vida
2023-06-01
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| Series: | Revista Portuguesa de Nefrologia e Hipertensão |
| Subjects: | |
| Online Access: | https://spnefro.pt/_doi/reference/54f5ab6f-fd11-45b0-8a3e-fcb42996087f |
| _version_ | 1797767140946739200 |
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| author | Juliana Carneiro João Grilo Joana Coutinho Raquel Chorão Ernesto Rocha |
| author_facet | Juliana Carneiro João Grilo Joana Coutinho Raquel Chorão Ernesto Rocha |
| author_sort | Juliana Carneiro |
| collection | DOAJ |
| description | Wunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated
complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high
index of suspicion, since its classical presentation with Lenk’s triad is only seen in less than a quarter of patients. Early detection is of outmost
importance because of this syndrome potential for causing hemodynamic instability and shock. Spontaneous renal hemorrhage has been
reported much less frequently in peritoneal dialysis as compared to hemodialysis. To our knowledge, only 3 single-cases involving peritoneal
dialysis patients were published since the year 2000. We describe an uncommon case report of a 68-year-old male undergoing continuous
ambulatory peritoneal dialysis for 5 years and taking warfarin for permanent atrial fibrillation who developed Wunderlich syndrome presenting
with Lenk’s triad. The patient was managed with percutaneous drainage of the renal hemorrhage and was able to continue peritoneal dialysis
in the acute phase of disease. Unfortunately, he subsequently developed peritoneal membrane failure having to transition to hemodialysis
2.5 months after the WS episode. The authors will review literature on Wunderlich syndrome on end-stage kidney disease patients, discuss
oral anticoagulation on peritoneal dialysis patients, maintenance of the technique, and finally, address the consequences of Wunderlich syndrome on peritoneal membrane diffusion capacity. |
| first_indexed | 2024-03-12T20:34:33Z |
| format | Article |
| id | doaj.art-b61f264fca514820ae59f378dc7a16c7 |
| institution | Directory Open Access Journal |
| issn | 0872-0169 2183-1289 |
| language | English |
| last_indexed | 2024-03-12T20:34:33Z |
| publishDate | 2023-06-01 |
| publisher | Publicações Ciência e Vida |
| record_format | Article |
| series | Revista Portuguesa de Nefrologia e Hipertensão |
| spelling | doaj.art-b61f264fca514820ae59f378dc7a16c72023-08-01T14:40:09ZengPublicações Ciência e VidaRevista Portuguesa de Nefrologia e Hipertensão0872-01692183-12892023-06-0137210611110.32932/pjnh.2023.06.242Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention?Juliana Carneiro0https://orcid.org/0009-0001-3078-9327João Grilo1https://orcid.org/0000-0002-2144-0780Joana Coutinho2https://orcid.org/0000-0002-5319-9370Raquel Chorão3https://orcid.org/0000-0002-3056-8129Ernesto Rocha4https://orcid.org/0000-0003-0983-0716 Internal Medicine Department, Centro Hospitalar Universitário Cova da Beira – Covilhã, PortugalNephrology Department, Unidade Local de Saúde de Castelo Branco, Castelo Branco, PortugalNephrology Department, Unidade Local de Saúde de Castelo Branco, Castelo Branco, PortugalNephrology Department, Unidade Local de Saúde de Castelo Branco, Castelo Branco, PortugalNephrology Department, Unidade Local de Saúde de Castelo Branco, Castelo Branco, PortugalWunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high index of suspicion, since its classical presentation with Lenk’s triad is only seen in less than a quarter of patients. Early detection is of outmost importance because of this syndrome potential for causing hemodynamic instability and shock. Spontaneous renal hemorrhage has been reported much less frequently in peritoneal dialysis as compared to hemodialysis. To our knowledge, only 3 single-cases involving peritoneal dialysis patients were published since the year 2000. We describe an uncommon case report of a 68-year-old male undergoing continuous ambulatory peritoneal dialysis for 5 years and taking warfarin for permanent atrial fibrillation who developed Wunderlich syndrome presenting with Lenk’s triad. The patient was managed with percutaneous drainage of the renal hemorrhage and was able to continue peritoneal dialysis in the acute phase of disease. Unfortunately, he subsequently developed peritoneal membrane failure having to transition to hemodialysis 2.5 months after the WS episode. The authors will review literature on Wunderlich syndrome on end-stage kidney disease patients, discuss oral anticoagulation on peritoneal dialysis patients, maintenance of the technique, and finally, address the consequences of Wunderlich syndrome on peritoneal membrane diffusion capacity.https://spnefro.pt/_doi/reference/54f5ab6f-fd11-45b0-8a3e-fcb42996087fhemorrhage/diagnosishemorrhage/etiologykidney failurechronicperitoneal dialysis/adverse effectwarfarin/adverse effects |
| spellingShingle | Juliana Carneiro João Grilo Joana Coutinho Raquel Chorão Ernesto Rocha Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? Revista Portuguesa de Nefrologia e Hipertensão hemorrhage/diagnosis hemorrhage/etiology kidney failure chronic peritoneal dialysis/adverse effect warfarin/adverse effects |
| title | Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? |
| title_full | Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? |
| title_fullStr | Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? |
| title_full_unstemmed | Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? |
| title_short | Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention? |
| title_sort | wunderlich syndrome in a peritoneal dialysis patient with warfarin iatrogenic coagulopathy should we really be so aggressive on cardioembolic events prevention |
| topic | hemorrhage/diagnosis hemorrhage/etiology kidney failure chronic peritoneal dialysis/adverse effect warfarin/adverse effects |
| url | https://spnefro.pt/_doi/reference/54f5ab6f-fd11-45b0-8a3e-fcb42996087f |
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