59 year old male presented with unabating frank haematuria

Renal Transplant 2008 – early transplant failure

MSU E Coli and Group Streptococcus – Norfloxacion + Amoxicillin

U/S – no obvious cause for haematuria from native or transplant kidneys

Cystoscopy GA cystoscopy, bladder wash out , bladder biopsy and cystodiathermy

Erythema on posterior wall and clots in the bladder (histology – mild inflammation and acute haemorrhage with dilated capillaries)

No bleeding seen coming from ureteric orifices

Bleeding time 15 mins.

Diagnosis of Uraemic bleeding dysfucntion

Further cystoscopy – to wash out clots

Haematological support Dialysis (BUN 29 and creat 10.9)

Blood (Hb 6.0)

FFP

Cryoprecipitate

IV Desmopressin (LIAT Barbados)

Conjugated oestrogens