BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI

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1 K CT Abstract A case of renal subcapsular hematoma resulting from trigger point injection under excessive effect of anticoagulant YAMANE Tateki, UMEDA Akira and SHIMAO Hitoshi An 85-year-old man who was taking Warfarin for an atrial fibrillation was admitted our hospital due to anemia. We gave him a transfusion and administrated vitamin K for the excessive effects of Warfarin. An abdominal CT scan showed a huge subcapsular hematoma of the left kidney, suggesting the cause of anemia. The patient had no episode of injury but had frequently undergone trigger point injection to the lumbar region for lumbago at a local clinic. The hematoma was regarded as an iatrogenic disease resulting from trigger point injection due to the excessive effects of the anticoagulant. Afterwards the hematoma was reduced, and the patient was discharged. A renal subcapsular hematoma usually occurs from injury, and iatrogenic cases are few in number. In iatrogenic cases the hematoma ordinarily results from renal biopsy or extracorporenal shock wave lithotripsy for renal stones. Cases related to lumbago therapy are rare, and moreover, cases concerned with antithrombotic agents have been nonexistent. This case is very rare, so we report it here. Keywords renal subcapsular hematoma, trigger point injection, anticoagulant 1 ESWL Division of Gastroenterology, Department of Internal Medicine, International University of Health and Welfare, Shioya Hospital 2 Division of Pulomonology, Department of Internal Medicine, International University of Health and Welfare, Shioya Hospital 3 Department of Surgery, International University of Health and Welfare, Shioya Hospital 43

2 BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI G 6.7 cm 1 2 ml WBC 5,210/μl T-BIL 1.0 mg/dl Fe 22 μg/dl NE 82.0% AST 25 IU/l TC 162 mg/dl LY 8.4% ALT 8 IU/l TG 73 mg/dl RBC / μl LDH 263 IU/l Hb 6.7 g/dl ALP 365 IU/l Ht 20.0% γ-gtp 42 IU/l CEA 4.2 ng/ml Plt /μl Ch-E 221 IU/l CA U/ml S-AMY 76 IU/l TP 6.6 g/dl PT-INR 7.67 alb 3.4 g/dl CRP 2.18 mg/dl BUN 24.8 mg/dl W-R Cr 0.96 mg/dl TPHA BNP pg/ml UA 4.9 mg/dl HBsAg Na 137 mmol/l HCVAb K 4.4 mmol/l Cl 100 mmol/l BS 94 mg/dl HbA1c 6.1% 44

3 CT 2 MRI a T1 b T2 T1 T2 T1 3 CT 3 4 CT 45

4 PT-INR 3.21 CT 110 mg 2/ 3 follow CT CT MRI 1/ cm CT 4 cm 1 T1 T2 T1 1 1 MRI , 2 CT 3 2 8, 9 page kidney 8, 9 9 ESWL 2 key word

5 ; 44: ; 36: ; 47: ; 41: ; 41: ; 52: ; 48: Grim CE, Mullins MF, Nilson JP et al. Unilateral Page kidney hypertension in man. Studies of the renin-angiotensinaldosterone system before and after nephrectomy. JAMA 1975; 231: Wheatley JK, Motamedi F, Hammonds WD. Page kidney resulting from massive subcapsular hematoma. Complication of lumbar sympathetic nerve block. Urology 1984; 24:

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