Michel C, Hufnagel G, Niang A, Shkiri H, Queffeulou G, Vrtovsnik F, Mignon F
Service de néphrologie, Hôpital Xavier Bichat, Paris.
Nephrologie. 2001;22(4):141-8.
The case presented in this study illustrates the peritoneal changes observed in long-term peritoneal dialysis (PD) patients. This male patient was on peritoneal dialysis (CAPD) for seven months before and 86 months after renal transplantation. Two episodes of peritonitis occurred during that time. The patient developed symptoms (ascites, gastro-intestinal disturbances, deteriorating general condition, inflammatory syndrome) four months after starting hemodialysis, one month after ablation of the PD catheter. Other potential causes (infection, malignancy, hepatitis, etc.) of these symptoms were ruled out following an exhaustive etiological work-up. A final diagnosis of sclerosing peritonitis was made, and the patient was started on corticosteroid therapy. Both morphological and functional alterations of the peritoneal membrane associated with long term PD and the detection of such alterations in everyday practice are reviewed here, along with possible etiological factors and therapeutic measures discussed in the literature. A better understanding of the pathophysiological mecHanisms underlying these alterations would make it possible to develop preventive measures, such as more biocompatible dialysates.
本研究中呈现的病例展示了长期腹膜透析（PD）患者所观察到的腹膜变化。该男性患者在肾移植前进行了7个月的腹膜透析（持续性非卧床腹膜透析），肾移植后进行了86个月。在此期间发生了两次腹膜炎。患者在开始血液透析4个月后、拔除PD导管1个月后出现症状（腹水、胃肠道紊乱、全身状况恶化、炎症综合征）。在进行详尽的病因检查后，排除了这些症状的其他潜在原因（感染、恶性肿瘤、肝炎等）。最终诊断为硬化性腹膜炎，并开始对患者进行皮质类固醇治疗。本文回顾了与长期PD相关的腹膜形态和功能改变以及在日常实践中对这些改变的检测，同时讨论了文献中提及的可能病因和治疗措施。更好地理解这些改变背后的病理生理机制将有助于制定预防措施，如使用生物相容性更好的透析液。
