[A case of hemolytic uremic syndrome accompanied by massive proteinuria and ascites]

A 50-year-old male was admitted to our hospital because of proteinuria, thrombocytopenia and moderate renal dysfunction. On admission, he had massive ascites, which was transudatory. During his clinical course, renal function deteriorated and the urine volume was decreased. Hemolytic uremic syndrome with massive ascites was diagnosed based on the finding of thrombocytopenia, acute renal failure and hemolytic anemia. Methylpredonisolone pulse therapy was not effective, but plasma exchange given 22 times in total combined with vincristine sulfate, PGI2 analogue and vitamin E administration was very effective for thrombocytopenia, renal dysfunction and hemolytic anemia. Massive ascites disappeared at the same time. After complete recovery of renal function, renal biopsy was performed, revealing the reticulation of mesangial matrix and mesangiolysis, which correspond to hemolytic uremic syndrome.