Suyama K, Kumano K, Go M, Sakai T
Department of Urology, Kitasato University, School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1994 Apr;85(4):664-7. doi: 10.5980/jpnjurol1989.85.664.
A peritoneal dialysis patient was reported who had ultrafiltration loss due to a marked increase in lymphatic absorption and peritoneal membrane permeability. A 33-year-old male was transferred from hemodialysis to peritoneal dialysis because of acute subdural hematoma. His complicated history included left testicular tumor with retroperitoneal lymph node metastasis in 1982. He was treated with CDDP, Etoposide, Bleomycin, Vinblastine sulfate and Vincristine and received operation of retroperitoneal lymph node dissection in 1982. He had been on hemodialysis since 1983 due to cisplatinum nephropaty. Ultrafiltration failure was found immediately following the insertion of Tenckhoff catheter without malfunction of peritoneal catheter. Peritoneal equilibrate test and lymphatic absorption measurement showed a high permeability peritoneum with a marked increase in lymphatic absorption rate (3.7 ml/min). These two factors were thought to result in ultrafiltration loss. CAPD with 4-6 times exchange daily did not maintain ultrafiltration, because it gave approximately 2000 ml negative water balance every day. He was well maintained on a short time exchange intermittent peritoneal dialysis (IPD) with cycler using 18 L for 8 hours. We concluded that increased lymphatic absorption is one of the important factors for ultrafiltration fafilure and IPD with frequent exchange by cycler is suitable for the patient with ultrafiltration loss.
据报道，一名腹膜透析患者因淋巴吸收和腹膜通透性显著增加而出现超滤丢失。一名33岁男性因急性硬膜下血肿从血液透析转为腹膜透析。他的复杂病史包括1982年左睾丸肿瘤伴腹膜后淋巴结转移。他于1982年接受顺铂、依托泊苷、博来霉素、硫酸长春碱和长春新碱治疗，并接受了腹膜后淋巴结清扫术。自1983年起，由于顺铂肾病，他一直接受血液透析。在插入Tenckhoff导管后立即发现超滤失败，腹膜导管无故障。腹膜平衡试验和淋巴吸收测量显示腹膜通透性高，淋巴吸收率显著增加（3.7 ml/分钟）。这两个因素被认为导致了超滤丢失。每天进行4至6次交换的持续性非卧床腹膜透析（CAPD）无法维持超滤，因为每天的负水平衡约为2000 ml。他通过使用18 L透析液循环8小时的短时间交换间歇性腹膜透析（IPD）得到了良好维持。我们得出结论，淋巴吸收增加是超滤失败的重要因素之一，对于超滤丢失的患者，使用循环器进行频繁交换的IPD是合适的。
