Medicinski vjesnik, Vol. 42 No. (1-2), 2010.
Recenzija, Prikaz slučaja
Sclerosing peritonitis after kidney transplantation - a case report
Lada Zibar
Goran Samardžija
Marko Jakić
Marijana Bilandžija
Jerko Barbić
Dubravka Mihaljević
Marija Minažek
Goran Kondža
Jasmina Rajc
Sažetak
Sclerosing peritonitis (SP) is rare and life threatening (mortality 30 93%) complication of peritoneal dialysis (PD). It appears in 0.6-3.3% of PD patients. Kidney transplantation (TX) increases the risk for SP (prevalence 7.5%). Ethiopathogenesis is unclear, while epidemiological data indicate risk factors (PD per se, long duration, hyperosmolar solutions for PD, reduced ultrafiltration-UF, beta blockers-BB) that change peritoneal cytokines equilibrium, increasing profibrotic transforming factor-ß (TGF- ß). Reduced fibrin clearance, considered to follow PD cessation, along with immunosuppressive (IS) drugs (calcineurin inhibitors, CNI, among them having profibrotic properties), increases the risk for PD after kidney TX. SP clinically resents by symptoms and signs of intestinal obstruction, and the diagnosis is being confirmed by abdominal computerized tomography, CT, (peritoneal thickening) and pathohistological analysis of peritoneal tissue. Preventive measures in the patients at risk are recommended, including specific IS after kidney TX. We present a case of a female patient with SP in the first year after kidney TX. Risk factors for SP in the patient were PD lasting for 7 years, reduced UF, hyperosmolar PD solutions, kidney TX, BB and CNI IS. The treatment, apart from surgery, included CNI and BB therapy cessation and mTOR inhibitor IS and tamoxifen introduction.
Ključne riječi
words: Sklerosing peritonitis; Peritoneal dialysis; Kidney transplantation; TGF- ß; mTOR inhibitors; Tamoxifen
Hrčak ID:
191884
URI
Datum izdavanja:
1.12.2010.
Posjeta: 793 *