Effective Management of Peritoneal Dialysis-Associated Hydrothorax in a Child: A Case Report

Abstract

Peritoneal dialysis (PD) confers many advantages, including a better quality of life for children with end-stage renal disease; however, the procedure is associated with several complications, including pleuroperitoneal leaks. Here, we report an unusual case of hydrothorax caused by long-term PD in a child, which was further complicated by pneumonia. A 9-year-old boy who had received CAPD for 22 months presented with dyspnea, swelling, and increased body weight. Chest tube drainage yielded 500 mL of transudative fluid. Computed tomography peritoneography revealed increased outflow from the peritoneum to the pleural cavity. PD was suspended, and hemodialysis (HD) was initiated. Video-assisted thoracoscopic surgery was performed; however, because the patient had pneumonia during hospitalization, pleural adhesions with a septated appearance occurred. This resulted in difficulties identifying pleuroperitoneal fistula (PPF). Right pleural effusion resolved following pleurodesis using bleomycin. Ambarsari et al.: Effective Management of PD-Associated Hydrothorax in a Child 19Regular HD was performed for 10 weeks, and PD was subsequently reinitiated. There was no recurrence of hydrothorax during long-term follow-up. We suspect that the underlying mechanism of hydrothorax in our patient was associated with a PPF that formed either due to a congenital diaphragmatic defect or an acquired defect, resulting in dialysate leakage. Our case demonstrates that a temporary switch from PD to HD, accompanied by pleurodesis, may help resolve hydrothorax that occurs as a complication of long-term PD.

Low-Dose Maintenance Intravenous Iron Therapy Can Prevent Anemia in Children with End-Stage Renal Disease Undergoing Chronic Hemodialysis

“…Availability of resources to diagnose and manage complex cases in Indonesia can be limited, therefore, we need to come up with alternative diagnostic tool or regimen. A recently published case from our center also reported the use of alternative medication because the recommended regimen is not available in Indonesia [33]. e present study provides valuable new data on the role of IV iron maintenance therapy on anemia in pediatric patients with ESRD who undergo regular HD.…”

An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child

“…The recent publications from our center displayed nonsurgical complications of PD in Indonesia, consist of fluid overload, hydrocele, omental wrapping, pleuroperitoneal fistula, malposition, and umbilical hernia; without any incidence of twisted PD catheter, suggesting its rarity. 1,3 Twisted catheter is typically associated with surgical complications during catheter insertion. 4 In our patient, the twisted catheter occurred during chronic catheter-site care.…”

Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study

“…However, it should be noted that factors predisposing to cardiovascular disease can be prevented by controlling blood pressure with antihypertensives, particularly after kidney transplantation. Indeed, hypertension has been reported in our cases of pediatric ESRD 6,32 . The target blood pressure in children with chronic kidney disease (CKD) is the 50th percentile (by age, sex, and height) unless there are signs and symptoms of hypotension, but this is probably overlooked in Indonesia and may result in dilated cardiomyopathy.…”