This is a 48-year-old male with a history of obesity, diet-controlled type 2 diabetes mellitus and smoking, who was diagnosed with renal failure secondary to rapidly progressive glomerulonephritis, with an estimated baseline antibodies.
For this reason, she received steroids, cyclophosphamide and plasmapheresis, all of them without satisfactory results for her renal function.
Initially he received renal replacement therapy by HD and later went to PD.
During the 5 years in this technique, the patient developed 10 episodes of peritonitis, 9 of them by Staphilococcus (8 epidermitis and 1 capitis).
The latter caused by Candida albicans, which led to the removal of the PD catheter and its transfer to HD.
During PD treatment, it became a "high transporter".
Six months after the change of therapeutic modality, the patient suffered abdominal pain with vomiting, weight loss, abdominal discomfort and hypogastric mass effect.
Abdominal ultrasound showed marked dilatation of the stomach and proximal loop of the small intestine, with moderately thickened wall; collection of fluid with multiple septa in the hypogastrium.
An abdominal computed axial tomography (CAT) was also performed, which showed the existence of a small amount of periheptic fluid retained in addition to perisplenic acid, with a small peritoneal thickening associated with a large gastric septa.
1.
On the other hand, surgical treatment was proposed for the patient, who was diagnosed with dementia.
The evolution was torpid, with several admissions due to intestinal occlusion, requiring parenteral nutrition, administration without success of steroids and progressive deterioration of his condition, with ascites and malnutrition that led to his death at 6 months.
1.
Results and description
1.
We have a number of predictive markers of this entity, such as time on PD, which is high carrier, and second recurrent factors (severe hyperparathyroidism (first case) or episodes of peritonitis).
It should be noted that more than half of the cases occur after discontinuation of the PD technique.
The diagnosis is made by imaging tests: simple X-ray, ultrasound or abdominal CT, although the definitive diagnosis can be obtained by peritoneal biopsy, where it can be seen an increase in the size of perivascular bleeding and capillary deposit of mononuclear fibrin.
The treatment of this severe condition depends on the degree of peritoneal involvement.
In the initial stages peritoneal rest could be sufficient, with peritoneal lavage and steroids.
In advanced cases, cyclosporine plus tapering of anaesthesia is required.
In extreme cases with visceral involvement, it may be necessary to resort to surgery, performing enterolysis, a technique that has a mortality rate between 40-80%.
Among the preventive measures for the development of sclerosing peritonitis, it is important to highlight the importance of the nursing role in patient training to reduce to the maximum the episodes of peritonitis and treat them adequately biocompatible high concentrations of glucose.
It is also very important to control secondary hyperparathyroidism in uremic patients.
Finally, we should be alert to those patients who become high transporters over time on PD.
Therefore, PET (peritoneal balance test) should be performed at least once a year and after peritonitis episodes.
