Time Is Not Always the Matter: An Instance of Encapsulating Peritoneal Sclerosis Developing in a Patient on Peritoneal Dialysis for a Short Term

Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with "second hit" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD. She was treated conservatively with nutritional support and was discharged in improved and stable clinical status.In general, the diagnosis of EPS requires clinical findings of bowel obstruction combined with typical computed tomography imaging features. However, the clinical manifestations can be very vague, and the diagnosis is often unclear. A recent study categorized EPS into 4 clinical stages, from pre-EPS to chronic ileus, with associated management from conservative treatment to surgical intervention.In association with second-hit risk factors, EPS can occur after short-term PD. Severity is variable, and the outcome is often devastating. Timely recognition and expert management of EPS can change the outcome very favorably.

Calciphylaxis and subtotal parathyroidectomy: a double-edged sword

Calciphylaxis, also called calcific uremic arteriolopathy is a dreadful, life-threatening ischemic vasculopathy, primarily involving skin and subcutaneous tissue, mostly on patients with end-stage kidney disease. Calciphylaxis is a well-described, but still a poorly understood disorder of mineral metabolism. Its occurrence is rare, but increasingly reported. We describe a 62-year-old obese lady on hemodialysis for end-stage kidney disease due to type 2 diabetes, who developed two episodes of calciphylactic skin lesions during the 3 years observation. The healing of lesions in the first episode was prompted by a subtotal parathyroidectomy for severe secondary hyperparathyroidism. However, the resumption of oral calcium and vitamin D analog for the parathyroidectomy-related hypocalcemia induced another occurrence of widespread calciphylactic skin lesions in areas of great adiposity. The typical regimen of IV sodium thiosulfate brought a successful outcome to the second episode. Now, growing numbers of successful treatment for calciphylaxis are reported with more specific therapies and a clear understanding of the pathogenetic mechanism is in sight.