Reversible Ultrafiltration Failure in a Peritoneal Dialysis Patient after Nephrectomy

超過濾不足是腹膜透析中一項嚴重的問題，它可能導致無法持續進行腹膜透析，甚至需要轉成血液透析。而長期透析病人是罹患泌尿道腫瘤的高風險族群，常需要接受手術治療。我們報告一位長期腹膜透析病人，因腎臟腫瘤而必需切除單側腎臟。術後發生傷口感染，即使感染已得到控制，但出現超過濾不足的現象，必須暫停腹膜透析，以短期血液透析取代，之後，病人得以重回腹膜透析並可以維持足夠的超過濾量，而且腹膜功能PET及透析廓清率Kt/V，WCCr與術前比較並無顯著差異。這個病例顯示，如果手術後有傷口感染等併發症，我們建議應該給予腹膜更長時間的休息，以避免其他併發症如超過濾不足的問題。

關鍵字

腹膜透析；腎臟切除；超過濾不足

並列摘要

We report a sixty-three years old woman with diabetes mellitus, end stage renal disease, and maintenance peritoneal dialysis (PD) who under went right radical nephrectomy for transitional cell carcinoma. Post-operative course was complicated by surgical wound infection and was successfully treated with antibiotic therapy. Postoperatively, patient was switched to hemodialysis (HD) for a short period of time. Then, PD was resumed as previous prescription after 17 days. However, over the next two months, patient developed clinical ultrafiltration failure manifested as increasing abdominal fullness and gradual weight gain of 10 kilograms. Abdominal CT revealed fluid infiltration within the subcutaneous tissue and muscle layers of the abdominal wall. She was again switched to HD and this treatment achieved adequate ultrafiltration with restoration of her prior dry weight 3 weeks later. Daily ultrafiltration remained adequate thereafter. Patient's dialysatel peritoneal creatinine ration and dialysis clearance after resolution of ultrafiltration failure was not affected compared with the values before nephrectomy. In this report, we will discuss the causes and management for ultrafiltration failure in PD patients, and the duration to hold PD after nephrectomy. In patients with perioperative complications, such as wound infection in our case, it may be necessary to hold PD longer so that the peritoneum has enough time to recover adequate ultrafiltration function.

並列關鍵字

nephrectomy ； peritoneal dialysis ； ultrafiltration failure

國際替代計量

Reversible Ultrafiltration Failure in a Peritoneal Dialysis Patient after Nephrectomy

全文下載

主題瀏覽