1
|
Al Riyami MS, Altalebi A, Al Hashmi S, Elfar A, Al Maskari A, Al Gaithi B, Al Saidi S, Al Baloshi S, Al Kalbani N. Improvement of Encapsulating Peritoneal Sclerosis After Medical Treatment and Successful Deceased Donor Kidney Transplant in a Child: A Case Report. Pediatr Transplant 2024; 28:e14867. [PMID: 39320007 DOI: 10.1111/petr.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is an uncommon complication of long-term peritoneal dialysis (PD). Despite its rarity, EPS significantly increases morbidity and mortality in patients undergoing prolonged peritoneal dialysis. In children on PD, the incidence of EPS ranges from 0.5% to 7.3%. CASE We present the case of a 13-year-old Omani boy diagnosed with end-stage kidney disease (ESKD) secondary to steroid-resistant nephrotic syndrome due to diffuse mesangial sclerosis at the age of 2 years. He was started on automated peritoneal dialysis (APD) on the same year and experienced four episodes of peritonitis, which were treated successfully with intraperitoneal (IP) antibiotics. In January 2023, he developed intermittent abdominal pain and chronic constipation, which progressed to daily vomiting, reduced oral intake, and weight loss. He later developed subacute intestinal obstruction which was managed conservatively. A CT scan of the abdomen revealed findings consistent with EPS. Following the diagnosis of EPS, peritoneal dialysis (PD) was discontinued, and the patient transitioned to hemodialysis. Treatment for EPS began with steroids and Tamoxifen. Subsequently, he underwent deceased donor kidney transplantation and was started on multiple immunosuppressive medications. During subsequent follow-up appointments, he was maintained on total parenteral nutrition (TPN) along with a soft diet. His overall condition improved significantly, enhancing his quality of life. CONCLUSION This case highlights the risk of encapsulating peritoneal sclerosis (EPS) in patients undergoing long-term peritoneal dialysis. Transitioning to hemodialysis and kidney transplantation, combined with targeted treatments such as steroids and Tamoxifen, significantly improved the patient's condition and quality of life. Early diagnosis and intervention are crucial for effective management of EPS in children.
Collapse
Affiliation(s)
- Mohamed S Al Riyami
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
- Pediatric Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Alaa Altalebi
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
| | - Samiya Al Hashmi
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
| | - Asama Elfar
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
| | - Anisa Al Maskari
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
| | - Badria Al Gaithi
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
- Pediatric Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Suliman Al Saidi
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
- Pediatric Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | | | - Naifain Al Kalbani
- Department of Child Healthy, Pediatric Nephrology Unit, Royal Hospital, Muscat, Oman
- Pediatric Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| |
Collapse
|
2
|
Shirai Y, Miura K, Ando T, Honda K, Segawa O, Hattori M. Asymptomatic Early-Stage Encapsulating Peritoneal Sclerosis Identified Laparoscopically. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 11:200110. [PMID: 38827480 PMCID: PMC11138254 DOI: 10.1016/j.jpedcp.2024.200110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Affiliation(s)
- Yoko Shirai
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Taro Ando
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuho Honda
- Department of Anatomy, School of Medicine, Showa University, Tokyo, Japan
| | - Osamu Segawa
- Department of Pediatric Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
3
|
Cumulative dialytic glucose exposure is a risk factor for peritoneal fibrosis and angiogenesis in pediatric patients undergoing peritoneal dialysis using neutral-pH fluids. Kidney Int Rep 2022; 7:2431-2445. [DOI: 10.1016/j.ekir.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
|
4
|
Leventoğlu E, Büyükkaragöz B, Dalgıç A, Fidan K, Söylemezoğlu O, Bakkaloğlu SA. Encapsulated Peritoneal Sclerosis in an Adolescent With Kidney Transplant After Long-Term Peritoneal Dialysis. EXP CLIN TRANSPLANT 2022; 20:112-114. [PMID: 35570613 DOI: 10.6002/ect.pediatricsymp2022.o35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Encapsulated peritoneal sclerosis is a rare complication of long-term peritoneal dialysis that has a high rate of morbidity and mortality. We present an 18-year-old female patient who was first diagnosed with renal failure at 8 years of age and who had 7 years of peritoneal dialysis and then hemodialysis before kidney transplant from a deceased donor. Before transplant, the patient developed encapsulated peritoneal sclerosis and was treated with tamoxifen and steroids. Three years after transplant, the patient presented with complaints of vomiting, abdominal pain, and abdominal distension and was again diagnosed with encapsulated peritoneal sclerosis. The patient required excretory paracentesis, pulse steroid treatment for 3 days, and treatment with methylprednisone and tamoxifen, which resulted in regression of signs and symptoms. Factors such as long-term peritoneal dialysis, a history of bacterial peritonitis, and use of high-concentration dialysate may cause encapsulated peritoneal sclerosis, but symptoms can recur after transplant, as shown in our patient. Thus, it is important to recognize that encapsulated peritoneal sclerosis may cause graft loss due to the various complications that it can cause.
Collapse
Affiliation(s)
- Emre Leventoğlu
- From the Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
5
|
Sharma V, Moinuddin Z, Summers A, Shenoy M, Plant N, Vranic S, Prytula A, Zvizdic Z, Karava V, Printza N, Vlot J, van Dellen D, Augustine T. Surgical management of Encapsulating Peritoneal Sclerosis (EPS) in children: international case series and literature review. Pediatr Nephrol 2022; 37:643-650. [PMID: 34448023 PMCID: PMC8921033 DOI: 10.1007/s00467-021-05243-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. METHODS Retrospective analysis of all paediatric patients with EPS treated at the Manchester Centre for Transplantation. RESULTS Four patients were included with a median duration of 78 months on PD. All patients had recurrent peritonitis (> 3 episodes), and all had symptoms within three months of a change of dialysis modality from PD to haemodialysis or transplant. In Manchester, care was delivered by a multi-disciplinary team, including surgeons delivering the adult EPS surgical service with a particular focus on nutritional optimisation, sepsis control, and wound management. The surgery involved laparotomy, lavage, and enterolysis of the small bowel + / - stoma formation, depending on intra-abdominal contamination. Two patients had a formal stoma, which were reversed at three and six months, respectively. Two patients underwent primary closure of the abdomen, whereas two patients had re-look procedures at 48 h with secondary closure. One patient had a post-operative wound infection, which was managed medically. One patient's stoma became detached, leading to an intra-abdominal collection requiring re-laparotomy. The median length of stay was 25 days, and patients were discharged once enteral feeding was established. All patients remained free of recurrence with normal gut function and currently two out of four have functioning transplants. CONCLUSIONS This series demonstrates 100% survival and parenteral feed independence following EPS surgery. Post-operative morbidity was common; however, with individualised experience-based decision-making and relevant additional interventions, patients made full recoveries. Health and development post-surgery continued, allowing the potential for transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Zia Moinuddin
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Angela Summers
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Mohan Shenoy
- grid.498924.a0000 0004 0430 9101Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas Plant
- grid.498924.a0000 0004 0430 9101Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Semir Vranic
- grid.412603.20000 0004 0634 1084College of Medicine, QU Health, Qatar University, Doha, Qatar ,grid.412603.20000 0004 0634 1084Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Agnieszka Prytula
- grid.410566.00000 0004 0626 3303Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Zlatan Zvizdic
- grid.411735.50000 0004 0570 5069Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Vasiliki Karava
- grid.4793.90000000109457005Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoleta Printza
- grid.4793.90000000109457005Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Vlot
- grid.5645.2000000040459992XSophia Children’s Hospital, Erasmus MC: University Medical Centre, Rotterdam, The Netherlands
| | - David van Dellen
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK ,grid.462482.e0000 0004 0417 0074Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
| | - Titus Augustine
- grid.498924.a0000 0004 0430 9101Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK ,grid.462482.e0000 0004 0417 0074Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
6
|
Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
Collapse
|
7
|
AlZabali SM, AlAnazi A, Rahim KA, Faqeehi HY. Clinical improvement of encapsulating peritoneal sclerosis after challenging course and 6 months of total parenteral nutrition in child with nephronophthisis: a case report. J Med Case Rep 2021; 15:366. [PMID: 34253224 PMCID: PMC8276428 DOI: 10.1186/s13256-021-02905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis is a rare but potentially lethal complication of long-term peritoneal dialysis that is associated with significant morbidity and mortality. The occurrence of encapsulating peritoneal sclerosis varies worldwide, but is increased in patients maintained on peritoneal dialysis for 5-8 years. The etiology of encapsulating peritoneal sclerosis remains unidentified, and a high index of clinical suspicion is required for diagnosis. CASE PRESENTATION We report a 5-year-old Saudi female with end-stage renal disease secondary to nephronophthisis type 2. She underwent peritoneal dialysis for 30 months, with four episodes of peritonitis. She presented with clinical signs of peritonitis. Three days later, she developed septic shock, which required pediatric intensive care unit admission. The peritoneal dialysis catheter was removed because of refractory peritonitis. Her course was complicated by small bowel perforation, and severe adhesions were revealed on abdominal ultrasound and computed tomography, consistent with a diagnosis of EPS. This finding was later confirmed by diagnostic laparotomy performed twice and complicated by recurrent abdominal wall fistula. She received total parenteral nutrition for 6 months and several courses of antibiotics. The patient received supportive treatment including nutritional optimization and treatment for infection. No other treatments, such as immunosuppression, were administered to avoid risk of infection. Following a complicated hospital course, the patient restarted oral intake after 6 months of total parenteral nutrition dependency. Her abdominal fistula resolved completely, and she was maintained on hemodialysis for few years before she received a kidney transplant. CONCLUSION When treating patients using peritoneal dialysis, it is important to consider encapsulating peritoneal sclerosis with refractory peritonitis, which is not always easy to identify, particularly if the patient has been maintained on peritoneal dialysis for less than 3 years. Early identification of encapsulating peritoneal sclerosis and appropriate conservative treatment, including nutritional optimization and treatment of infections, are essential to achieve a better prognosis.
Collapse
Affiliation(s)
- Saeed Mohammed AlZabali
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Abdulkarim AlAnazi
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khawla A Rahim
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan Y Faqeehi
- Pediatric Nephrology Section, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
An unusual complication of peritoneal dialysis: Answers. Pediatr Nephrol 2021; 36:2061-2063. [PMID: 33768326 DOI: 10.1007/s00467-021-05016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 10/21/2022]
|
9
|
Wright E, Fischbach M, Zaloszyc A, Paglialonga F, Aufricht C, Dufek S, Bakkaloğlu S, Klaus G, Zurowska A, Ekim M, Ariceta G, Holtta T, Jankauskiene A, Schmitt CP, Stefanidis CJ, Walle JV, Vondrak K, Edefonti A, Shroff R. Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes. Pediatr Nephrol 2016; 31:137-43. [PMID: 26386590 DOI: 10.1007/s00467-015-3204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/13/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemodialysis (HD) in children with a concomitant ventriculoperitoneal shunt (VPS) is rare. Registry data suggest that peritoneal dialysis with a VPS is safe, but little is known about HD in the presence of a VPS. METHODS We performed a 10-year survey to determine the prevalence of a VPS, complications and outcome in children with a VPS on HD in 15 dialysis units from the 13 countries participating in the European Pediatric Dialysis Working Group. RESULTS Eleven cases of HD with a VPS were reported (prevalence 1.33 %; 328 patient-months) and compared with prospective Registry data. The median age at start of dialysis was 9.6 [inter-quartile range (IQR) 1.0-15.0] years and median HD vintage was 2.4 (IQR 1.7-3.0) years. Dialysis was performed through a central venous line (CVL) and through an arteriovenous fistula in six and five children, respectively. Three CVL infections occurred in two children, but these children did not develop VPS infections or meningitis. Symptoms of hemodynamic instability were reported in six (55 %) children at least once per week, with hypotension or hypertension occurring in four of these children and nausea, vomiting and headaches occurring in two; four other children reported less frequent symptoms. Seizures on dialysis occurred in two children, at a frequency of less than once per month, with one child also experiencing visual disturbances. During follow-up (median 4.0; IQR 0.38-7.63 years), three children remained on HD and eight had a functioning transplant. No patients were switched to PD. CONCLUSIONS Hemodialysis in children with a VPS is safe, but associated with frequent symptoms of hemodynamic instability. No episodes of VPS infection or meningitis were seen among the children in the survey, not even in those with CVL sepsis.
Collapse
Affiliation(s)
- Elizabeth Wright
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Stephanie Dufek
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | | | | | - Gema Ariceta
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | - Alberto Edefonti
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK.
| | | |
Collapse
|