A Case of ‘Sweet’ Hydrothorax in a Patient on Peritoneal Dialysis

摘要

Non-infectious complications are an important cause of peritoneal dialysis failure. Increased intra-abdominal pressure resulting from dialysate inflow into the peritoneal cavity can cause leaks, including hydrothorax due to pleuroperitoneal communication. The authors describe a patient on peritoneal dialysis with a newly discovered pleural effusion with a high glucose level. The patient was treated conservatively with peritoneal dialysis cessation and switched to haemodialysis with complete resolution of the pleural effusion. After 5 weeks, the patient successfully restarted peritoneal dialysis without recurrence of the hydrothorax.LEARNING POINTS class="unordered" style="list-style-type:disc">Pleural effusion in a patient on peritoneal dialysis can be caused by leakage of dialysate through pleuroperitoneal communication.Pleural effusion as a result of dialysate leak is rich in glucose.If conservative treatment with temporary peritoneal dialysis cessation is unsuccessful, any pleuroperitoneal communication should be surgically repaired. class="kwd-title">Keywords: Peritoneal dialysis, pleuroperitoneal communication, pleural effusion class="head no_bottom_margin" id="__sec2title">HOSPITAL GRAND ROUNDS>UKC Maribor, by Editorial Board Member Radovan HojsUniversity Medical Centre (UKC) Maribor, Slovenia, provides secondary and tertiary healthcare services to patients from Maribor and northeastern part of Slovenia. It has status of teaching hospital and it is learning base for medical students. The origin of UKC Maribor reaches back to the Maribor city hospital that has been treating patients since 14th century and constantly developing since its official establishment in 1799. Today UKC Maribor employs 3400 staff members, of them approx. 600 medical doctors.Part of UKC Maribor is Clinic for Internal medicine that includes departments of Cardiology and Angiology, Gastroenterology, Endocrinology and Diabetology, Nephrology, Dialysis, Rheumatology, Haematology and Hematologic Oncology, Pulmonary Diseases, Nuclear Medicine, Internal Intensive Medicine and Emergency Medical Unit. class="head no_bottom_margin" id="__sec3title">INTRODUCTIONPeritoneal dialysis (PD), haemodialysis (HD) and kidney transplantation are offered to patients with end-stage renal disease (ESRD). Kidney transplantation is the gold standard, offering the longest patient survival. The differences in prognosis between PD and HD patients are not as well known, with some studies showing improved survival of patients on PD, especially in the first few years of renal replacement therapy^[]. Due to its efficacy, high patient satisfaction and lower costs compared with HD, PD remains an important dialysis option^[]. In the past few years, the rates of infectious complications, especially peritonitis, have been reduced. However, this achievement has not been matched by improved management of non-infectious complications of PD^[].