Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam.
Faculty of Medicine, University of New South Wales, Sydney, Australia.
Saudi J Kidney Dis Transpl. 2020 May-Jun;31(3):687-692. doi: 10.4103/1319-2442.289455.
Chylous nephrogenic ascites is rare in hemodialysis (HD) patients. We would like to share a rare case of chylous nephrogenic ascites in a HD patient. The patient has a history of straw-colored nephrogenic ascites which was drained through pigtail five times in the past. Later on, the ascites became turbid and milky. The chloroform test of the ascitic fluid showed fat globules with Oil Red-O stain, and the triglyceride concentration of ascitic fluid was 168.14 mg/dL (1.93 mmol/L) satisfying the criteria of chylous ascites. We believe that this may be caused by microtrauma from repeated pigtail insertions for ascites which was compounded by inadequate HD and noncompliance with fluids. Routine investigations including screening for malignancy, tuberculosis, cirrhosis, and heart failure did not reveal any other possible causes. Although there are few case reports of chylous ascites in peritoneal dialysis patients, it has never been reported in patients on HD.
乳糜性肾源性腹水在血液透析（HD）患者中较为罕见。我们将分享一例 HD 患者乳糜性肾源性腹水的罕见病例。该患者既往有乳糜性腹水病史，曾通过猪尾管引流腹水 5 次。后来，腹水变得混浊和乳白色。腹水的氯仿试验显示油红 O 染色的脂肪球，腹水的甘油三酯浓度为 168.14mg/dL（1.93mmol/L），符合乳糜性腹水的标准。我们认为这可能是由于反复进行猪尾管插入引流腹水导致的微创伤，加上 HD 不充分和液体摄入不规范所致。常规检查包括恶性肿瘤、结核、肝硬化和心力衰竭的筛查，并未发现其他可能的原因。尽管腹膜透析患者乳糜性腹水的病例报告较少，但在 HD 患者中从未有过报道。
