Ferrara Elizabeth, Lemire Jacques, Grimm Paul C, Reznik Vivian M, Mendoza Stanley A, Leake John A, Benador Nadine M
Department of Pediatrics, Division of Pediatric Nephrology, University of California San Diego, 200 W. Arbor Drive MC 0831, San Diego, CA 92103, USA.
Pediatr Nephrol. 2004 Jan;19(1):114-7. doi: 10.1007/s00467-003-1348-1. Epub 2003 Nov 25.
Peritonitis is the most common complication and the leading cause of death in pediatric peritoneal dialysis (PD) patients. According to the most recent data available from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), approximately 25% of pediatric PD patients who die succumb to infection. There are no reported cases of Mycobacterium tuberculosis (MTB) or Mycobacterium avium-intracellulare peritonitis in the NAPRTCS registry. With an increasing incidence of MTB worldwide and the impairment of cellular immunity in chronic renal failure patients, it is not surprising that mycobacterium peritonitis can occur in PD patients. We report two pediatric PD patients with mycobacterial peritoneal infection diagnosed over an 11-year period at our institution. One patient presented with a malfunctioning Tenckhoff catheter and again 3 years later with hyponatremia and ascites. The other presented with recurrent culture-negative peritonitis. These cases illustrate the importance of more extensive evaluation of PD complications, to include evaluation for mycobacterium with special media or peritoneal biopsy, in the above clinical settings if the routine work-up is unrevealing.
腹膜炎是儿童腹膜透析（PD）患者最常见的并发症和主要死因。根据北美儿科肾移植协作研究（NAPRTCS）的最新数据，约25%死亡的儿童PD患者死于感染。在NAPRTCS登记处没有报告过结核分枝杆菌（MTB）或鸟分枝杆菌-胞内分枝杆菌腹膜炎的病例。随着全球MTB发病率的上升以及慢性肾衰竭患者细胞免疫功能受损，PD患者发生分枝杆菌腹膜炎并不奇怪。我们报告了在我们机构11年间诊断出的两名患有分枝杆菌腹膜感染的儿童PD患者。一名患者最初出现Tenckhoff导管功能障碍，3年后又出现低钠血症和腹水。另一名患者表现为反复培养阴性的腹膜炎。这些病例说明了在上述临床情况下，如果常规检查无异常，对PD并发症进行更广泛评估的重要性，包括使用特殊培养基或腹膜活检来评估分枝杆菌。
