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Lymphoid Peritoneal Fluid as a Variant of Chylous-Like Effluent in Peritoneal Dialysis: Proposal for a New Diagnostic

Nigel Fernandez-Carlos1, Maria L Ocampo1, Carlos G Musso1

  • 1Nephrology Division. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|May 7, 2025
PubMed

Insights

Cloudy peritoneal dialysis fluid can indicate infection or other issues. This case describes a unique milky effluent, termed "lymphoid fluid," in a patient undergoing peritoneal dialysis, which is not chylous or pseudochylous.

Area of Science:

  • Nephrology
  • Peritoneal Dialysis
  • Gastroenterology

Background:

  • Cloudy peritoneal dialysis effluent typically suggests infectious peritonitis or non-infectious causes.
  • Etiologies for cloudy effluent can include increased cellularity or low/acellular counts, with fibrin or fat aiding diagnosis in the latter.
  • A whitish, cloudy appearance often indicates high fat content (chyloperitoneum), stemming from pharmacological, traumatic, or inflammatory origins.

Purpose of the Study:

  • To report a novel case of turbid, acellular peritoneal effluent with a milky appearance in a patient with stage 5 chronic kidney disease on continuous ambulatory peritoneal dialysis.
  • To investigate the etiology of this unique effluent, which presented with negative cultures and low triglyceride and cholesterol levels.
  • To propose a new term, "lymphoid fluid," to describe this specific type of peritoneal effluent that resembles lymphatic fluid but lacks high lipid content.

Main Methods:

  • Case report of a patient with stage 5 chronic kidney disease initiating continuous ambulatory peritoneal dialysis.
  • Analysis of peritoneal effluent for cellularity, presence of fibrin or fat, and physicochemical evaluation including triglyceride and cholesterol levels.
  • Microbiological cultures to rule out infectious peritonitis.

Main Results:

  • The patient presented with turbid, acellular peritoneal effluent exhibiting a milky, chylous-like appearance.
  • Physicochemical evaluation revealed low levels of triglycerides and cholesterol.
  • Cultures were negative, ruling out infectious peritonitis.

Conclusions:

  • The described effluent does not meet the criteria for chylous or pseudochylous fluid due to low lipid levels.
  • The term "lymphoid fluid" is proposed to describe this milky-looking effluent that resembles lymphatic fluid.
  • This represents the first reported case of such an effluent and the proposal of a specific descriptive term in the literature.

Keywords:
chyloperitoneumperitoneal dialysis

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