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Recurrent diffuse alveolar haemorrhage in a patient receiving dialysis
Tomoyuki Ogata1, Susumu Takahashi2, Kentaro Nakamura2
1Department of Respiratory Medicine, JA Toride Medical Center, Toride, Japan ogatatomoyuki262626@gmail.com.
BMJ Case Reports
|October 8, 2025
Summary
This case study shows a dialysis patient with recurrent diffuse alveolar haemorrhage (DAH). Low-dose aspirin cessation and steroids improved DAH, suggesting aspirin may contribute to this condition in dialysis patients.
Area of Science:
- Nephrology
- Pulmonology
- Internal Medicine
Background:
- Patients undergoing maintenance dialysis have complex health needs.
- Diffuse alveolar haemorrhage (DAH) is a rare but serious complication.
- Cardiovascular risk is high in dialysis patients, often necessitating antithrombotic therapy.
Purpose of the Study:
- To report a case of recurrent DAH in an elderly dialysis patient.
- To investigate the potential role of low-dose aspirin in DAH development.
- To emphasize individualized antithrombotic management in this population.
Main Methods:
- Case report of an 80s male on maintenance dialysis.
- Clinical presentation: acute respiratory failure, recurrent DAH.
- Diagnostic tools: Chest CT, bronchoscopy.
- Therapeutic interventions: high-dose steroids, low-dose aspirin management.
Main Results:
- Patient experienced recurrent DAH despite initial steroid treatment.
- DAH resolved upon cessation of low-dose aspirin and reinstitution of steroids.
- Cautious reintroduction of aspirin with maintenance steroids showed no recurrence.
Conclusions:
- Low-dose aspirin may contribute to DAH in dialysis patients.
- Individualized antithrombotic strategies are crucial.
- Steroid therapy remains important for managing DAH in this context.
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