An autopsy case of interlobar arterial dissection of the kidney following long-term hemodialysis

An autopsy case of massive renal hemorrhage in a 49-year-old male who had undergone maintenance hemodialysis for 8 years, is reported. No bleeding tendency had been noticed, and blood pressure had been reduced to within the normal range. Histological investigation with semiserial sections revealed that hemorrhage had occurred in four arteries, corresponding to the interlobar, arcuate, and interlobular levels, which existed in the same ruptured cyst wall. Acute dissection had occurred in two of the four arteries, leading to rupture of the cyst; this led to destruction of the remaining arteries. Both kidneys, which were markedly shrunken and had numerous cysts in the cortex and medulla, fell into the category of acquired cystic renal disease of long-term hemodialysis. It was suspected that renal vascular change during hemodialysis, mechanical factors compressing the protruding artery in the cyst with scanty renal interstitium, and relatively radical hemodynamic changes during dialysis had contributed to the hemorrhage.