Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
BMC Nephrol. 2020 Jul 15;21(1):277. doi: 10.1186/s12882-020-01939-x.
Tetralogy of Fallot is the most common cyanotic congenital heart disease. Patients with the condition have a high risk of developing chronic kidney disease. Treatment of kidney disease in patients with complex hemodynamics presents unique challenges. However, there are very few reports on the treatment of end-stage renal failure in patients with tetralogy of Fallot.
We present a rare case of peritoneal dialysis in a 47-year-old man with tetralogy of Fallot who had not undergone intracardiac repair. Peritoneal dialysis successfully removed fluids and solutes without adversely affecting the patient's hemodynamics. Our patient was managed with peritoneal dialysis for 5 years before he succumbed to sepsis secondary to digestive tract perforation.
In this paper, we discuss the importance of monitoring acid-base balance, changes in cyanosis, and hyperviscosity syndrome during peritoneal dialysis in patients with tetralogy of Fallot. Lower leg edema and B-type natriuretic peptide level were useful monitoring parameters in this case. This case illustrates that with attention to the patient's unique requirements, peritoneal dialysis can provide successful renal replacement therapy without compromising hemodynamics in patients with tetralogy of Fallot.
法洛四联症是最常见的发绀型先天性心脏病。该病症患者发生慢性肾脏病的风险很高。治疗复杂血流动力学患者的肾脏病具有独特的挑战。然而，关于法洛四联症患者终末期肾衰竭的治疗，仅有非常少的报道。
我们报告了 1 例罕见的法洛四联症 47 岁男性患者的病例，该患者未接受过心脏内修复术。腹膜透析成功地清除了液体和溶质，而不会对患者的血流动力学产生不利影响。我们的患者接受腹膜透析治疗 5 年后，因消化道穿孔继发感染性休克而死亡。
本文讨论了在法洛四联症患者进行腹膜透析时监测酸碱平衡、发绀变化和高粘滞综合征的重要性。在这种情况下，小腿水肿和 B 型利钠肽水平是有用的监测参数。该病例说明，只要注意患者的特殊需求，腹膜透析就可以为法洛四联症患者提供成功的肾脏替代治疗，而不会影响血流动力学。
