A 65-year-old woman with stage V CRE secondary to chronic glomerulonephritis associated with morbid obesity corrected by bariatric surgery.
After receiving education on treatment options HD, multiple non-functioning AVFs are performed, in this situation we decided to perform CAPD.
In November 2014, a 2-cuff Swan-neck silicone catheter was implanted.
Their body surface area was 1.58 m2 and Body Mass Index was 24.1.
The education for learning the technique was carried out, and in mid-December 2014 began treatment at home with 4 exchanges of diuresis and 35 to 1.36% of glucose and 1500 ml volume, without complications, with 16 hours of residual volume
Given the good tolerance the volume was progressively increased to 2000 ml.
At the end of January 2015 a peritoneal function test was performed and classified as high carrier with a residual volume of 425.68 ml and intraperitoneal pressure (IPP) of 17.7 cm H2O.
On March 1, 2015, the patient came to the emergency department complaining of difficulty in drainage and dyspnea at rest. The intestinal pattern was normal, with no constipation or diarrhea.
The abdominal X-ray showed migration of the catheter and the thorax bilateral pleural effusion.
Laxatives and enemas were administered to facilitate catheter repositioning, diuretics and hypertonic exchanges to correct overhydration and the infusion volume was decreased to alleviate dyspnea.
However, drainages remained very irregular and never complete.
1.
Toracentesis was performed and the pleural fluid obtained showed results compatible with dialysis fluid.
The suspicion of fluid leakage into the pleural cavity was temporarily suspended.
Peritoneal scintigraphy was performed administering 181.3 MBq albumin nanocolloid TC 99 m, the drug radio was infused and diluted in the dialysis solution and drained at the end of the test, according to the protocol.
The study, as early as in the reading, showed an image indicative of peritoneal-pleural communication in the right hemithorax, confirming the suspicion of fluid leakage into the pleural cavity, so that the catheter was finally suspended HD.
Currently, she remains on HD with good adaptation and tolerance to the technique.
