血液透析が誘因となって出血性脳梗塞をきたしたと考えられた糖尿病性腎不全の1例

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  • Report of a case diabetic renal failure with hemorrhagic cerebral infarction induced by hemodialysis

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A 55-year-old non-insulin dependent diabetic female patient with nephropathy was admitted to our institute for acute myocardial infarction. In spite of intensive cardiac management her condition was complicated by further deterioration of renal function due to massive cerebral infarction and gastrointestinal bleeding during her hospital stay. Hemodialysis was selected for treatment of hypercatabolism because of hemodynamic stability. During the first hemodialysis treatment the patient became comatose, and computed tomography of the brain revealed hemorrhagic cerebral infarction with severe brain edema.<br>Although the dialysis procedure was switched to continuous peritoneal dialysis after the above episode using the osmotic agents glycerol and mannitol intravenously to remove brain edema, the patient died due to brain stem herniation without recovering consciousness.<br>Peritoneal dialysis should be recommended not only far patients with cerebral hemorrhage but also for patients with massive cerebral infarction to prevent hemorrhagic infarction and the elevation of intracranial pressure induced by hemodialysis.

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