Centro Hospitalar Vila Nova de Gaia/Espinho, Departamento de Nefrologia, Vila Nova de Gaia, Portugal.
J Bras Nefrol. 2022 Oct-Dec;44(4):587-591. doi: 10.1590/2175-8239-JBN-2021-0001.
Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.
包裹性腹膜硬化症是腹膜透析的一种罕见但严重的并发症。在大多数情况下，症状出现在腹膜透析停止后，这阻碍了其诊断。我们报告了一例 44 岁的白人男性，他接受腹膜透析治疗 6 年零 3 个月，因超滤失败而改为血液透析。在他接受腹膜透析的最后几个月，他出现了食欲不振和乏力，最初归因于透析不足。血液透析诱导后，患者出现腹痛、腹部体积增加、便秘与腹泻交替、体重减轻。计算机断层扫描显示新出现的腹水。考虑早期包裹性腹膜硬化症的诊断，并立即开始营养支持、口服泼尼松龙和他莫昔芬治疗 1 年。患者症状缓解。治疗结束后 1 个月，他成功进行了肾脏移植，没有任何重大并发症。早期诊断包裹性腹膜硬化症需要高度的临床怀疑，因为该疾病在晚期可能致命。本病例强调，在包裹性腹膜硬化症发作后，早期治疗可成功进行肾脏移植。
