Hypoxic hepatitis due to atrial fibrillation combined with sleep apnea syndrome in hemodialysis patients: two case reports

Higashi Keishi, Fukushima Tatsuro, Nishiyama Junichiro

doi:10.4009/jsdt.53.559

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Other Title

心房細動と睡眠時無呼吸症候群の関与が考えられた低酸素性肝炎の血液透析2症例
症例報告心房細動と睡眠時無呼吸症候群の関与が考えられた低酸素性肝炎の血液透析2症例
ショウレイホウコクシンボウサイドウトスイミンジムコキュウショウコウグンノカンヨガカンガエラレタテイサンソセイカンエンノケツエキトウセキ 2 ショウレイ

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Abstract

<p>Here, we report two cases of hypoxic hepatitis (HH) involving chronic hemodialysis patients. Both patients were males in their 70s. Patient 1 was transferred to our hospital with a mild consciousness disorder and Cheyne-Stokes respiration. Patient 2 visited the emergency room on foot, complaining of pyrexia and shortness of breath, and was admitted to be treated for bronchopneumonia. Both patients exhibited abrupt marked increases in their transaminase levels without any specific symptoms. Their liver injuries had not been caused by viruses or drugs. Their serum transaminase levels spontaneously returned to baseline levels within two weeks. Both patients suffered atrial fibrillation, causing heart failure and sleep apnea syndrome (SAS). Finally, we diagnosed the patients with HH. HH, which is also referred to as “ischemic hepatitis” or “shock liver”, is characterized by a massive, rapid rise in serum transaminase levels, resulting from reduced oxygen delivery to the liver. The major causes of HH are septic shock, respiratory failure, and heart failure. In hemodialysis patients, atrial fibrillation and SAS are well known complications. Thus, we suggest that HH should be included in the differential diagnoses when an unexpected liver injury is found in a hemodialysis patient.</p>

Journal

Nihon Toseki Igakkai Zasshi

Nihon Toseki Igakkai Zasshi 53 (11), 559-565, 2020

The Japanese Society for Dialysis Therapy

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