Zenasni Nadia, Elkhayat Salma, Taleb Sara, Zamd Mohammed, Medkouri Ghizlaine, Benghanem Gharbi Mohammed, Ramdani Benyounes, Aschawa Hind, Guensi Amal
Service de néphrologie-dialyse-transplantation rénale, CHU IBN-Rochd de Casablanca, Casablanca, Maroc.
Service de néphrologie-dialyse-transplantation rénale, CHU IBN-Rochd de Casablanca, Casablanca, Maroc.
Nephrol Ther. 2015 Apr;11(2):114-7. doi: 10.1016/j.nephro.2014.11.007. Epub 2015 Feb 21.
Iodine-131 ablation therapy for thyroid cancer in the patient on chronic hemodialysis represents a real problem since the main route of elimination of radioiodine is urinary. There is no recommendation on the management of this treatment in the patient on hemodialysis. We report our experience of management of this treatment in a patient aged 38 years, undergoing hemodialysis for chronic renal failure, and who have been indicated the treatment with iodine-131 for papillary thyroid carcinoma high risk. After multidisciplinary discussions (nephrologists and specialists in nuclear medicine and radiation safety), it has been decided to treat the patient with continuous ambulatory peritoneal dialysis therapy (CAPD). Because of the low but continuous elimination of iodine in the case of CAPD, the patient received a reduced ablative (131)I dose of 1850 MBq, which is 30% of the usual dose delivered in subjects with normal renal function. The patient was hospitalized for four days in nuclear medicine unit and the (131)I radioactivity emitted from him was 2.5 μSv/h at one meter at his hospital discharge. In conclusion, CAPD in relay of hemodialysis is a technique of renal replacement therapy that can be suggested to minimize exposure to radioactivity to the patient, his family and the medical staff.
对于接受慢性血液透析的甲状腺癌患者，碘-131消融治疗是一个实际问题，因为放射性碘的主要排泄途径是通过尿液。目前对于血液透析患者的这种治疗管理尚无相关建议。我们报告了对一名38岁患者的治疗管理经验，该患者因慢性肾衰竭接受血液透析，且因高危乳头状甲状腺癌而接受碘-131治疗。经过多学科讨论（肾病科医生、核医学和辐射安全专家），决定采用持续非卧床腹膜透析疗法（CAPD）对该患者进行治疗。由于CAPD情况下碘的排泄量低但持续，该患者接受了1850 MBq的减少剂量消融碘-131治疗，这是肾功能正常患者通常剂量的30%。患者在核医学科住院四天，出院时在距离他一米处测得其发出的碘-131放射性为2.5 μSv/h。总之，CAPD接力血液透析是一种肾脏替代治疗技术，可建议采用以尽量减少患者、其家人和医护人员所受的放射性暴露。
