Tranexamic Acid Treatment of Life-Threatening Hematuria in Polycystic Kidney Disease

A 41-year-old woman with autosomal dominant polycystic kidney disease had chronic kidney disease class IV. She presented 10 days postpartum with a 4-day history of severe hematuria, left flank pain, and anemia, hemoglobin 62 g/L. CT scan showed massively enlarged kidneys with multiple cysts; several cysts bilaterally had high attenuation consistent with hemorrhage. Hematuria persisted over several days despite intensive conservative measures that included vitamin K1, 4 units of plasma, transfusion of 10 units of packed RBCs, Darbopoeitin, and DDAVP. Antifibrinolytic therapy was given with tranexamic acid 1000 mg p.o. t.i.d for one day then OD. The hematuria stopped within 24 hours and did not recur after tranexamic acid therapy ended. Over the next 4 years there were 3 hospitalizations each with severe gross hematuria requiring blood transfusion for acute anemia. The hematuria responded well to further treatment with tranexamic acid. Tranexamic acid produces antifibrinolytic effects via complex interactions with plasminogen, displacing plasminogen from the fibrin surface. Chronic renal impairment is considered a relative contraindication to use of tranexamic acid due to reports of ureteric clots and acute renal failure from cortical necrosis. We conclude that tranexamic acid can be used safely in some patients with CKD and polycystic kidney disease to treat severe hematuria

Mucosal Healing in Crohn's Disease: Bull's Eye or Bust? The Relative Con Position

Background: Crohn's disease is a progressive inflammatory bowel disease. Persistent untreated inflammation can cumulatively result in bowel damage in the form of strictures, fistulas, and fibrosis, which can ultimately result in the need for major abdominal surgery. Mucosal healing has emerged as an attractive, yet ambitious goal in the hope of preventing long-term complications. Summary: Clinical remission is an inadequate measure of disease activity. Noninvasive markers such as fecal calprotectin, CRP, or small bowel ultrasound are useful adjunct tools. However, endoscopic assessment remains the cornerstone in building a treatment plan. Achieving complete mucosal healing has proved to be an elusive goal even in the ideal setting of a clinical trial. Key Messages: Aiming for complete mucosal healing in all patients may result in overuse of medications, higher costs, and potential side effects of aggressive immunosuppressive treatment. More practical goals such as relative or partial healing, for example, 50% improvement in inflammation and reduction in size of ulcers, ought to be considered, particularly in difficult-to-treat populations. © 2021 The Author(s). Published by S. Karger AG, Basel