Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
Pediatr Nephrol. 2018 Jul;33(7):1155-1156. doi: 10.1007/s00467-017-3821-2. Epub 2017 Oct 24.
Acute pancreatitis can be a life-threatening complication in patients with chronic kidney disease (CKD), especially in kidney transplant recipients.
CASE DIAGNOSIS/TREATMENT: The patient was 7 years old when he received renal transplantation for CKD secondary to posterior urethral valves. Two years later, he presented with severe necrotizing pancreatitis (Ranson's score 5, Balthazar's score 8). Viral and genetic testing came back negative; pancreatitis was attributed to the patient's treatments (prednisone, trimethoprim-sulfamethoxazole, and everolimus). Twenty days later, necrotized pancreatic cysts had formed. Two drains were surgically inserted into the abdomen, and continuous cyst lavage was started with normal saline solution. Two days later, blood tests revealed severe hypernatremia and hypokalemia. We suspected unwanted peritoneal dialysis had occurred because of the high sodium chloride content and the absence of potassium in the normal saline solution being used for cyst lavage. We switched to a peritoneal dialysis solution for the lavage, leading to complete correction of hydroelectrolytic disorders.
Acute pancreatitis is a frequent and potentially severe complication in CKD patients. It should be suspected in the presence of nonspecific symptoms, such as abdominal pain or vomiting. Rigorous monitoring of electrolytes is also mandatory for managing CKD patients with acute pancreatitis.
急性胰腺炎在慢性肾脏病（CKD）患者中可能是一种危及生命的并发症，尤其是在肾移植受者中。
病例诊断/治疗：该患者因后尿道瓣膜病导致 CKD 于 7 岁时接受肾移植。2 年后，他出现严重的坏死性胰腺炎（Ranson 评分 5，Balthazar 评分 8）。病毒和基因检测结果均为阴性；胰腺炎归因于患者的治疗（泼尼松、甲氧苄啶-磺胺甲噁唑和依维莫司）。20 天后，形成了坏死性胰腺囊肿。手术插入两根引流管到腹部，并开始用生理盐水进行持续的囊腔冲洗。两天后，血液检查显示严重的高钠血症和低钾血症。我们怀疑由于使用的生理盐水含高氯化钠且不含钾，导致了不必要的腹膜透析。我们将冲洗液切换为腹膜透析液，从而完全纠正了水电解质紊乱。
急性胰腺炎是 CKD 患者常见且潜在严重的并发症。在出现腹痛或呕吐等非特异性症状时应怀疑该病。对于患有急性胰腺炎的 CKD 患者，还必须严格监测电解质。
