Editor:Drainage failure is one of the peritoneal dialysis (PD) catheter-related problems that cause morbidity and greatly reduce quality of life (1). We report here 2 cases of outflow failure due to neurogenic bladder.The first case was a 62-year-old female with diabetic nephropathy. Peritoneal dialysis was initiated 4 years prior, and 1 year later, hemodialysis (HD) was combined with PD. She developed outflow failure, but X rays showed no signs of catheter malposition. Suction and injection of fibrinolytic agent had no effect. A plain computed tomography (CT) scan revealed the tip of the catheter pressed against the abdominal wall by a dilated bladder containing a large amount of urine (Figure 1), despite the fact that she had been considered to be anuric for several years. Approximately 1 L of urine was drained by urethral catheterization, and outflow failure was completely resolved.The second case was a 79-year-old male with diabetic nephropathy with a 3-year history of PD, and 8-month history of bimodal therapy with PD and HD. He experienced sudden outflow failure, but X rays, intraluminal suction or injection,
Recently, a large randomized placebo-controlled trial indicated a beneficial effect of tolvaptan on the progression of autosomal dominant polycystic kidney disease (ADPKD) with near-normal kidney function. Meanwhile, the evidence of tolvaptan's efficacy in ADPKD with severe renal insufficiency was limited and higher frequency of liver enzyme elevations were observed in patients taking tolvaptan. Liver transplantation (LT) is the only curative treatment for patients with severe polycystic liver disease associated with ADPKD, but considering that liver injuries should be avoided particularly in patients who underwent LT, we must be careful to start tolvaptan in post-LT ADPKD patients. We describe the case of a patient who had developed severe renal insufficiency after living donor LT, for whom tolvaptan therapy showed marked reduction of total kidney volume and maintenance of renal function without any serious adverse events. This is the first report to show the beneficial effect and safety of tolvaptan, in a post-LT ADPKD patient with severe renal insufficiency, and hopefully will help broaden the spectrum of patients who will benefit from tolvaptan.
In this retrospective study comprising a small number of cases, increased attenuation of fatty tissue around the Tenckhoff catheter correlated with exit-site or tunnel infections. CT might be an auxiliary tool for diagnosis, although CT costs much more than US and is not always available in general practice. Further prospective studies are needed. .
An 83-year-old female patient with a 3-year history of peritoneal dialysis (PD) for diabetic nephropathy presented to our clinic with abrupt dialysate drainage failure. The Tenckhoff catheter inserted 3 years ago was a two-cuffed, straight-type flexible silicone tube. Before presentation, she had no abnormal sensation in the abdomen, had not performed any vigorous exercises, or received external force to the abdomen that could have caused catheter damage. No crack or fracture was observed in the PD catheter outside the exit site.Computed tomography revealed a completely amputated PD catheter. The break point of the catheter was B5 mm from the inner side of the peritoneal cuff. The distal part of the broken catheter was lying freely in the peritoneal cavity ( Figure 1). Open surgery was performed to repair the PD access and remove the broken catheter. An incision was made near the peritoneal cuff. Rectal sheaths were opened for inspection of the abdominal cavity ( Figure 2). The broken catheter was found lying in the pelvis within finger's reach, and was removed manually. For preserving the percutaneous cuff and exit site, a new catheter was connected and placed in the rectouterine excavation. After the repair, the patient experienced no major access-related complications.With the advent of silicone rubber catheters that are specially designed for PD treatment, the incidence of catheter-related complications has reduced, and the patency of catheters has increased compared with that in the early years of PD treatment. Catheter amputation in the intraperitoneal cavity is rare. In this case, no clinical symptoms or findings indicative of catheter amputation were observed, and the mechanism of the damage is not known.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.