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Shah M, Mcnamara B, Abdel-Rahman EM. Early-Onset Dyspnea in a Patient Initiating Peritoneal Dialysis. KIDNEY360 2024; 5:929-930. [PMID: 38935494 PMCID: PMC11219100 DOI: 10.34067/kid.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Monarch Shah
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Brendan Mcnamara
- University of Virginia School of Medicine, Charlottesville, Virginia
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Jonny J, Violetta L. Bilateral Pleural Effusion in Continuous Ambulatory Peritoneal Dialysis Managed by Vats Pleurodesis. Eur J Case Rep Intern Med 2024; 11:004343. [PMID: 38584902 PMCID: PMC10997387 DOI: 10.12890/2024_004343] [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: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Pleuroperitoneal leak as a cause of pleural effusions in peritoneal dialysis is a rare but important complication to consider in continuous ambulatory peritoneal dialysis (CAPD) patients presenting with recurrent progressive dyspnoea. Generally, these effusions are unilateral and right-sided, resulting in shortness of breath and reduced ultrafiltration volume, which are initially managed by peritoneal rest. We describe a case of bilateral pleural effusions in a 57-year-old female on chronic CAPD who developed recurrent progressive dyspnoea but maintained adequate dialysis output. A chest radiograph revealed bilateral pleural effusions with high glucose content, and scintigraphy confirmed the existence of a definite pleuroperitoneal communication. She was managed by temporary substitution to haemodialysis, followed by suturing of the shunt and successful video-assisted thoracoscopic surgery (VATS) pleurodesis with an aldehyde-based surgical glue. Unexplained recurring dyspnoea in chronic CAPD should raise the suspicion of a possible pleuroperitoneal leak, even in patients without an apparent loss of ultrafiltration. Pleurodesis using an aldehyde-based adhesive was effective and tolerated well by our patient and may be considered in managing cases of recurrent pleural effusion. LEARNING POINTS Recurrent dyspnoea in a chronic peritoneal dialysis patient should raise the diagnosis of a possible pleuroperitoneal leak, even if no apparent loss of ultrafiltration was observed.Minimally invasive surgical pleurodesis using surgical adhesive can be considered in cases of refractory pleuroperitoneal leak.
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Affiliation(s)
- Jonny Jonny
- Division of Nephrology, Department of Internal Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
- Faculty of Medicine, Prima University, Medan, Indonesia
- Faculty of Medicine, Jakarta Veterans National Development University, Jakarta, Indonesia
- Faculty of Military Medicine, Indonesia Defense University, Bogor, Indonesia
| | - Laurencia Violetta
- Division of Nephrology, Department of Internal Medicine, Gatot Soebroto Central Army Hospital, Jakarta, Indonesia
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Kwan VSY, Leibowitz S. Delayed pleuroperitoneal leak in an otherwise uncomplicated course of peritoneal dialysis. Clin Case Rep 2023; 11:e7469. [PMID: 37323290 PMCID: PMC10264940 DOI: 10.1002/ccr3.7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
Key Clinical Message Pleuroperitoneal leaks are rare and normally arise as an early complication in peritoneal dialysis. This case illustrates the importance of considering pleuroperitoneal leaks as a cause for pleural effusions-even if peritoneal dialysis has been longstanding and uncomplicated. Abstract A 66-year-old male on peritoneal dialysis for 15 months presented with dyspnoea and low ultrafiltration volumes. Chest radiography revealed a large right-sided pleural effusion. Pleural fluid sampling and peritoneal scintigraphy confirmed a pleuroperitoneal leak.
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Affiliation(s)
- Victor Shou Yee Kwan
- Greater Brisbane Clinical SchoolThe University of QueenslandBrisbaneQueenslandAustralia
| | - Saskia Leibowitz
- Department of NephrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Ino J, Suzuki S, Hoshino J. Prolonged scintigraphy in the diagnosis of pleuroperitoneal communication. Perit Dial Int 2022:8968608221123110. [PMID: 36062455 DOI: 10.1177/08968608221123110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jun Ino
- Department of Nephrology, Toda Central General Hospital, 1-19-3 Hon-cho, Toda City, Saitama, Japan
| | - Shota Suzuki
- Department of Nephrology, Toda Central General Hospital, 1-19-3 Hon-cho, Toda City, Saitama, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, Japan
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Granata A, Rahbari E, Pesce F, Gesualdo L, Zeiler M. Contrast-enhanced ultrasound in peritoneal dialysis: when and how to perform it. J Nephrol 2022; 35:1329-1337. [PMID: 35275378 DOI: 10.1007/s40620-022-01287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
In the field of peritoneal dialysis contrast enhanced ultrasound (CEUS) is a new add-on examination to B-mode ultrasound, but until recently it has never been systematically studied. Based on the experience of the Project Group "Integrated Imaging and Interventional Nephrology" of the Italian Society of Nephrology, CEUS is helpful for evaluating catheter malfunction, peritoneal-pleural communication, leakage, and herniation, and in particular it facilitates dynamic functional imaging of the catheter and its complications. The use of CEUS in peritoneal dialysis is simple, repeatable, safe, radiation-free, and appears to be less time-consuming and more cost-effective than other radiological imaging techniques such as peritoneography, computed tomography, magnetic resonance or peritoneal scintigraphy.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Elnaz Rahbari
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Francesco Pesce
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, "C. e G. Mazzoni" Hospital, Via degli Iris 1, 63100, Ascoli Piceno, Italy.
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Berliner C, Boss K, Pape A, Kribben A, Fendler W, Herrmann K. [Oldies (but Goldies): Peritoneal Scintigraphy in Chronic Peritoneal Dialysis Patients]. Nuklearmedizin 2021; 60:450-453. [PMID: 34433221 DOI: 10.1055/a-1542-6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Kristina Boss
- Klinik für Nephrologie, Universitätsklinikum Essen, Germany
| | - Anke Pape
- Klinik für Nephrologie, Universitätsklinikum Essen, Germany
| | | | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Germany
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Duquennoy S, Leduc V, Podevin E. Imaging and leaks in peritoneal dialysis. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysate leaks are non-rare mechanical but dreaded complications in peritoneal dialysis (PD). They usually occur at the beginning of PD, with various clinical events depending on their location. Use of imaging tests such as computed tomography (CT) peritoneography, or magnetic resonance imaging (MRI) peritoneography, or scintigraphic peritoneography, can confirm the diagnosis and guide surgical intervention if needed. These simple, non-invasive, and accessible tests can be done in collaboration between the radiological et peritoneal teams. Depending on the leakage site, PD can be pursued with small volumes with a cycler. In other cases, it must be interrupted and the patient transferred to hemodialysis, in order to permit the peritoneal cavity to regain its integrity by cicatrization or with surgical intervention. Imaging can help to make sure peritoneal cavity has regained its integrity after this period of transition. Early leaks can be avoided by delaying PD start with by 14 days. Intraperitoneal pressure does not seem to contribute significantly. Prevention of PD leaks essentially depends on individual risk factors such as obesity or anterior abdominal surgeries. This article reviews the characteristics of dialysate leaks in PD and the imagery tests to limit transfer to hemodialysis.
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Pascal P, Nogier MB. Non-infectious complications of peritoneal dialysis and peritoneal scintigraphy. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Peritoneal dialysis (PD) is an alternative to hemodialysis that is indicated in patients with chronic end-stage disease. It has many advantages, but also complications such as dialysate leaks around the catheter insertion site, in the abdominal wall or in the pleural cavity, inguinoscrotal hernia and even intra-abdominal fluid collection.
Peritoneal scintigraphy is a simple, non-invasive, low-irradiation examination, without the risk of allergy, that allows both diagnosing and locating these complications because it allows acquiring images at the time of infusion, as well as remotely and after drainage of the dialysate. Tomoscintigraphy coupled with scanner SPECT / CT (Single Photon Emission Computed Tomography / Computed Tomography) can also help narrow the diagnosis.
The objective of this article is to clarify the value of peritoneal scintigraphy in the diagnosis of non-infectious complications of peritoneal dialysis, the conditions for performing the examination and the potential indications, as illustrated by a few cases.
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