自然消失した血液透析患者の紫色蓄尿バッグ症候群

Spontaneously vanished purpule urine bag syndrome seen in a patient receiving hemodialysis

　83歳，女性．腎後性腎不全を原疾患とし，2023年3月より血液透析を受けていた．

　両側腎に尿管カテーテル，膀胱には尿道バルーンが留置されており，1日尿量は1000〜2000mLを排出していたが，ADL/QOL低下と尿路感染症を合併していた．10月初めより蓄尿バッグおよび連結チューブに青色の変色を認めるようになった．抗菌薬投与後も膿尿，細菌尿は持続したが，臨床症状なく経過していた．その後，身体機能の向上により腎機能の改善と紫色蓄尿バッグ症候群が消失し，透析回数は週2回に変更された．血液透析患者における紫色蓄尿バッグ症候群の管理には感染コントロールに加えて，腸内環境や栄養状態，運動機能などの改善が大切であると考えられた．

Abstract

A 83-year-old female who has been receiving maintenance hemodialysis (HD) for post renal failure since March 2023 has been indwelling bilateral ureteral stent and urethral balloon catheter. She excreted 1000―2000mL of urine volume per day, however, was complicated by urinary tract infection (UTI) and deterioration of ADL/QOL. On the beginning of October, the urine bag and connecting tube discolored blue-color. Even after administration of antimicrobial agent, pyuria and bacteriuria still persisted. But her clinical manifestations were not evident. Thereafter, the purple urine bag syndrome (PUBS) spontaneously vanished, and then hemodialysis was altered to two times a week due to the recovery of ADL and renal function. It was considered that the improvement of bowel environment and nutritional condition and also physical ability including UTI control were most important for the management of PUBS in hemodialysis patients (Rinsho Hinyokika 78 : 603-606, 2024).