A 58-year-old man with a body surface area of 2.02 m presented with ischemic heart disease and chronic renal failure secondary to nephroangiocarcinoma.
When informed about dialysis techniques, PD was chosen when the patient wanted home treatment.
A self-locating catheter was implanted without incidents for PD using the surgical method.
A preoperative chest X-ray showed no pleural effusion or other remarkable changes.
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On March 30, 2004, continuous ambulatory PD (CAPD) was initiated with three daily exchanges of 2,000 cc to 1.36%.
After 48 hours, the patient reported drains of 2,500 cc after 8 h of stay, so the regimen was modified to 2 daily exchanges with the same volume and glucose to minimize the negative effect of the residual kidney function ultra.
After 1 week in CAPD, on the 6-April-2004 the patient consulted for dyspnea on medium efforts with orthopnea of 48 hours of evolution.
There was abundant diuresis, drainages of 2,300-2,400 cc by exchange and stable weight.
The examination revealed a decrease in vesicular murmur in the right lung base, compatible with the existence of pleural effusion at this level, which was confirmed on a chest X-ray.
A diagnosis of hydrothorax was suspected in CAPD. She remained asymptomatic for right diagnosis. She showed a clear yellow fluid with proteins < 1 g/dl, 17 leu/mm3, 40 hem/mm3 and 197 ambulant glycemia.
The symptoms improved the following day and in a review carried out one week later the absence of pleural effusion was found.
On April 20, 2004, after 2 weeks without PD, the patient was admitted and ADPKD was restarted in decubitus with 6 exchanges/day from 1,000 cc to 1.36% to minimize the initial hydrothorax recurrence.
After 4 days without problems, the infusion volume increased to 1,500 cc and ambulation was allowed.
The patient was discharged on April 27, 2004.
After 3 days at home and 10 days after restarting CAPD, the patient returned to the hospital with recurrence of the right hydrothorax.
On this occasion, and after suspending CAPD immediately, a haemodialysis (HD) catheter was implanted in the right femoral vein.
The good evolution of the case during the first days after restarting CAPD encouraged us to a new attempt to solve the problem by peritoneal rest, this time longer.
31 hours later chest-2004, after a month of peritoneal rest, the patient restarted CAPD again with 5 daily exchanges of 1,000 cc to 1.36% and absolute bed rest, with only 48 recurrences of hydrochlorothiazide
Again, CAPD was stopped and HD was restarted.
Established the ineffectiveness of conservative treatment, and according to the patient, talc pleurodesis was indicated that the thoracic surgeons performed the 18-June-2004 without further incidents or problems.
A chest X-ray performed 4 days after elective chest surgery showed no pleural effusion.
After keeping the patient on HD for 5 more weeks as recommended by thoracic surgeons, on July 26, 2004 restart CAPD with 4 exchanges/day from 1500 cc to 1.36%, this time without incidence
Currently, 15 months after restarting CAPD after pleurodesis, the patient continues on CAPD without recurrence of hydrothorax, uses 4 exchanges/day of the patient who had chosen dialysis 1.36% and is truly satisfied with dialysis.
