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[Peritoneal sclerosis in children under treatment with peritoneal dialysis]
S Moriya1, H Koshino, K Iitaka
1Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.
Insights
Peritoneal sclerosis is a serious complication of peritoneal dialysis (PD) in children. Regular peritoneal biopsies are recommended to detect this condition early and switch patients to hemodialysis (HD) if necessary.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Renal Failure Complications
Background:
- Peritoneal dialysis (PD) is a vital treatment for pediatric end-stage renal failure.
- Peritoneal sclerosis represents a significant, serious complication of long-term PD therapy.
- Early detection and management are crucial for patient outcomes.
Observation:
- Four pediatric patients on PD were diagnosed with peritoneal sclerosis between 1997-1998.
- All patients had a history of bacterial peritonitis but were clinically stable on PD.
- Patients had undergone PD for a mean of 9 years (range 4-14 years) and were anuric.
Findings:
- Peritoneal sclerosis can develop even in children maintained in good clinical condition on PD.
- Long-term PD use, even without apparent functional decline, poses a risk for sclerosis.
- Serial peritoneal biopsies, especially during catheter changes, are essential for early diagnosis.
Implications:
- Patients diagnosed with peritoneal sclerosis require a transition from PD to hemodialysis (HD).
- Switching to HD is critical to prevent the progression of life-threatening peritoneal sclerosis.
- This highlights the need for vigilant monitoring in pediatric PD patients.
Abstract:
Peritoneal dialysis(PD) is an established method of dialysis for children at the end stage of renal failure. Among several problems associated with PD, peritoneal sclerosis is one of the most serious complications. We examined four children on PD who were diagnosed as having peritoneal sclerosis in 1997 and 1998. Three of these cases were switched to hemodialysis(HD) and one is now undergoing a switch from PD to HD. Although all of the four patients had a history of bacterial peritonitis, they had been maintained in a fairly good condition on PD. The mean duration of PD was 9 years(4-14 years). All cases were anuric and had been maintained on PD without any problems of peritoneal function. From these observations, we should consider peritoneal sclerosis even in patients with a good clinical condition during the long-term period of PD. We recommend serial peritoneal biopsies, at least at the time of peritoneal catheter changes, to check for peritoneal sclerosis. The patients who are diagnosed as having sclerotic thickening of the peritoneal membrane should be switched from PD to HD to prevent the occurrence of life-threatening peritoneal sclerosis.