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The Use of Pleural Fluid to Serum Glucose Ratio in Establishing the Diagnosis of a Not So Sweet PD-Related Hydrothorax: Case Report and Literature Review. Case Rep Nephrol 2020; 2020:8811288. [PMID: 32963857 PMCID: PMC7492928 DOI: 10.1155/2020/8811288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022] Open
Abstract
Hydrothorax is a well-known but rare complication of peritoneal dialysis (PD), with an average incidence of 2% mainly in cases of continuous ambulatory peritoneal dialysis (CAPD). In more than 80% of these cases, the hydrothorax is attributed to an abnormal pleuroperitoneal communication. It commonly manifests as unilateral effusion, predominantly on the right. A thoracentesis to determine pleural glucose has been a diagnostic aid well relied on, as the dextrose rich dialysate raises the pleural fluid glucose. A pleural fluid glucose to serum glucose gradient greater than 50 mg/dL is suggestive of a leak with a specificity of 100% according to some studies; however, its sensitivity is variable. Our case illustrates a diagnostic dilemma due to a relatively low pleural fluid to serum glucose gradient of 21 mg/dL that caused a delay in diagnosis. A pleural fluid to serum glucose ratio >1.0 was used as a diagnostic marker that pointed toward a peritoneal leak. For confirmation, a peritoneal scintigraphy with nuclear technetium 99 scan was performed that revealed a pleuroperitoneal fistula as the source of the recurring hydrothorax in the setting of automated peritoneal dialysis (APD). The hydrothorax completely resolved with termination of APD on follow-up as the patient was transitioned to intermittent hemodialysis (HD).
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Akimoto T, Yamazaki T, Kohara M, Nakagawa S, Kanai Y, Izawa S, Yamamoto H, Nakazawa E, Masuda T, Kobayashi T, Saito O, Muto S, Kusano E, Nagata D. Pleuroperitoneal Communication and Ovarian Cancer Complicating Peritoneal Dialysis: A Case Report of a Patient with End-Stage Kidney Disease. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617735818. [PMID: 29085240 PMCID: PMC5648088 DOI: 10.1177/1179547617735818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022]
Abstract
Peritoneal dialysis has been a widely accepted modality for treating end-stage kidney disease, but a regular dialysis schedule can be seriously disrupted by various comorbid conditions requiring surgical intervention. A 40-year-old woman who had been receiving peritoneal dialysis was sequentially but separately complicated by pleuroperitoneal communication and ovarian cancer. Despite the need for temporary interruption of her peritoneal dialysis schedule, it was successfully resumed after the relevant surgeries for each disease. Several concerns regarding overall postoperative dialytic management strategies, including how to deal with the peritoneal dialysis catheter during the postoperative period as well as how long peritoneal dialysis should be interrupted, which remain an unresolved issue in the field of nephrology, are also discussed.
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Affiliation(s)
- Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomoyuki Yamazaki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Marina Kohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshihiko Kanai
- Division of Thoracic Surgery, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Sayoko Izawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hisashi Yamamoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.,Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Eiko Nakazawa
- Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takahisa Kobayashi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.,Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
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Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation. World J Surg 2015; 39:128-32. [PMID: 25189449 DOI: 10.1007/s00268-014-2761-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) pneumoperitoneum under procedural sedation is a technique that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center. METHODS Data from 87 consecutive patients who underwent LPDC insertion was retrospectively reviewed. All procedures were attempted under procedural sedation. After patients received intravenous and local anesthesia, a N2O pneumoperitoneum was established. Peritoneal dialysis (PD) catheters were advanced using rectus sheath tunneling. The position of the catheter was confirmed by laparoscope, and adjunct procedures such as omentopexy and adhesiolysis were performed on select patients to prevent catheter flow problems. RESULTS Nitrous oxide was well tolerated by 94 % of the patients. Only five patients required conversion to general anesthesia. After a mean follow-up of 18.2 months, mechanical complications included pericatheter/incision leakage (12.62 %), flow obstruction (4.60 %), incision/exit site hernia (3.45 %), hemoperitoneum (2.30 %), pleuroperitoneal fistula (1.15 %), scrotal leak (1.15 %), and migration (1.15 %). Infectious complications included exit site infection (1 episode per 312.95 patient-months) and peritonitis (1 episode per 31.93 patient-months). Revision-free catheter survival was 97.6 % after 1 year. CONCLUSION Laparoscopic implantation of a PD catheter with N2O pneumoperitoneum and local anesthesia is safe and effective in patients with severe renal failure. N2O is an inert gas and better tolerated as an insufflation agent, enabling awake procedures. Our results show that catheter-related functional outcomes are comparable to those in the existing literature. This approach can be recommended as a good option for catheter implantation in patients needing dialysis.
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