Peritoneal dialysis in a patient with neurogenic bladder and chronic kidney disease with ventriculoperitoneal shunt

Area of Science:

• Nephrology
• Pediatric Nephrology
• Neurosurgery

Background:

• Continuous ambulatory peritoneal dialysis (PD) has improved long-term dialysis for children with multiple handicaps.
• An increasing number of spina bifida patients are utilizing PD due to improved survival rates.
• The safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) remains a subject of discussion.

Observation:

• A 17-year-old female with meningomyelocele, hydrocephalus, and neurogenic bladder, managed with a VPS, developed end-stage renal failure.
• She was initiated on PD, experiencing an uneventful initial 9 months.
• Subsequently, she developed fungal peritonitis, successfully treated with catheter removal and intravenous amphotericin B; cerebrospinal fluid remained sterile.

Findings:

• This is the first reported case of fungal peritonitis in a spina bifida patient on PD with a functioning VPS.
• The patient's ventriculoperitoneal shunt (VPS) did not appear to be the source of the fungal infection.
• Peritoneal dialysis (PD) can be considered in patients with a functioning ventriculoperitoneal shunt (VPS) but requires vigilant monitoring.

Implications:

• Peritoneal dialysis (PD) is a feasible treatment for end-stage renal disease in spina bifida patients with ventriculoperitoneal shunts (VPS).
• Healthcare providers should be aware of the potential for serious infectious complications, such as fungal peritonitis, in this patient population.
• Careful patient selection and close monitoring are crucial for managing PD in patients with complex neurological conditions and shunts, especially in resource-limited settings.