The present case was a 59-year-old woman who underwent a right
nephrectomy at 30 years of age, and in whom renal dysfunction occurred at 51 years of age. In November 199X, when her
creatinine level reached 7 mg/dl,
renal replacement therapy was recommended. She refused this
therapy and began her own
diet therapy, which consisted of taking only supplement beverage, but no food. Afterwards she became unable to do daily work, and entered our hospital in July of the next year. On admission, her bleeding time was over 10 minutes, but coagulation function tests showed normal values. Platelet function tests showed that coagulation with the addition of
ADP was mildly decreased and that coagulation with the addition of aggregation was severely decreased. These data and her
bleeding tendency improved with
hemodialysis. Therefore, a diagnosis of aggregation non-responsive uremic platelet dysfunction was made. On admission, we were not able to insert a
catheter for
hemodialysis because of her severe
bleeding tendency. A
platelet transfusion was made so that we could insert the
catheter without severe
bleeding. However, this
hemostatic effect lapsed after about five to six hours. Six hours after insertion of the
catheter, oozing from the orifice of the
catheter was seen and a red
blood transfusion was necessary. Three days after beginning
hemodialysis, the
bleeding tendency was no longer seen. Her platelet function and coagulation test results also improved. We can make two conclusions regarding this case. The first is when the physician's medical strategy cannot be carried out due to uremic platelet dysfunction, a
platelet transfusion can temporarily eliminate the
bleeding tendency. The second is that the pathophysiology of uremic platelet dysfunction involves suppression of the primary step of platelet aggregation with
collagen. Experience with the present case revealed the appropriate therapeutic strategy for the pathophysiology of uremic platelet dysfunction.