scholarly journals A Successful Treatment of Encapsulating Peritoneal Sclerosis in an Adolescent Boy on Long-term Peritoneal Dialysis: A Case Report

2020 ◽  
Vol 121 (4) ◽  
pp. 254-261
Author(s):  
Zlatan Zvizdic ◽  
Angela Summers ◽  
Zia Moinuddin ◽  
David Van Dellen ◽  
Irmina Pasic-Sefic ◽  
...  

Encapsulating peritoneal sclerosis (EPS) is a rare life-threatening complication associated with peritoneal dialysis (PD). EPS is characterized by progressive fibrosis and sclerosis of the peritoneum, with the formation of a membrane and tethering of loops of the small intestine resulting in intestinal obstruction. It is very rare in children. We present a case of a 16-year-old adolescent boy who developed EPS seven years after being placed on continuous ambulatory peritoneal dialysis (CAPD) complicated by several episodes of bacterial peritonitis. The diagnosis was based on clinical, radiological, intraoperative and histopathological findings. The patient was successfully treated with surgical enterolysis. During a 7-year follow-up, there have been no further episodes of small bowel obstruction documented. He still continues to be on regular hemodialysis and is awaiting a deceased donor kidney transplant. EPS is a long-term complication of peritoneal dialysis and is typically seen in adults. Rare cases may be seen in the pediatric population and require an appropriate surgical approach that is effective and lifesaving for these patients.

2007 ◽  
Vol 68 (1) ◽  
pp. S27
Author(s):  
Tatiana Michelon ◽  
Cristina Sandri ◽  
Mikki Osawa ◽  
Paul Terasaki ◽  
Jorge Neumann

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003668
Author(s):  
Piero Ruggenenti ◽  
Paolo Cravedi ◽  
Eliana Gotti ◽  
Annarita Plati ◽  
Maddalena Marasà ◽  
...  

Background We compared protection of mycophenolate mofetil (MMF) and azathioprine (AZA) against acute cellular rejection (ACR) and chronic allograft nephropathy (CAN) in kidney transplant recipients on steroid-free, low-dose cyclosporine (CsA) microemulsion maintenance immunosuppression. Methods and findings ATHENA, a pragmatic, prospective, multicenter trial conducted by 6 Italian transplant centers, compared the outcomes of 233 consenting recipients of a first deceased donor kidney transplant induced with low-dose thymoglobulin and basiliximab and randomized to MMF (750 mg twice/day, n = 119) or AZA (75 to 125 mg/day, n = 114) added-on maintenance low-dose CsA microemulsion and 1-week steroid. In patients without acute clinical or subclinical rejections, CsA dose was progressively halved. Primary endpoint was biopsy-proven CAN. Analysis was by intention to treat. Participants were included between June 2007 and July 2012 and followed up to August 2016. Between-group donor and recipient characteristics, donor/recipient mismatches, and follow-up CsA blood levels were similar. During a median (interquartile range (IQR)) follow-up of 47.7 (44.2 to 48.9) months, 29 of 87 biopsied patients on MMF (33.3%) versus 31 of 88 on AZA (35.2%) developed CAN (hazard ratio (HR) [95% confidence interval (CI)]: 1.147 (0.691 to 1.904, p = 0.595). Twenty and 21 patients on MMF versus 34 and 14 on AZA had clinical [HR (95% CI): 0.58 (0.34 to 1.02); p = 0.057) or biopsy-proven subclinical [HR (95% CI): 1.49 (0.76 to 2.92); p = 0.249] ACR, respectively. Combined events [HR (95% CI): 0.85 (0.56 to 1.29); p = 0.438], patient and graft survival, delayed graft function (DGF), 3-year glomerular filtration rate (GFR) [53.8 (40.6;65.7) versus 49.8 (36.8;62.5) mL/min/1.73 m2, p = 0.50], and adverse events (AEs) were not significantly different between groups. Chronicity scores other than CAN predict long-term graft outcome. Study limitations include small sample size and unblinded design. Conclusions In this study, we found that in deceased donor kidney transplant recipients on low-dose CsA and no steroids, MMF had no significant benefits over AZA. This finding suggests that AZA, due to its lower costs, could safely replace MMF in combination with minimized immunosuppression. Trial registration ClinicalTrials.gov NCT00494741; EUDRACT 2006-005604-14.


2019 ◽  
Vol 17 (6) ◽  
pp. 714-719
Author(s):  
Shahad Farhan Alenazi ◽  
Ghada Mahaya Almutairi ◽  
Maha Ahmed Sheikho ◽  
Mona Ahmed Al Alshehri ◽  
Batool Mousa Alaskar ◽  
...  

2019 ◽  
Vol 24 (4) ◽  
pp. 356-368 ◽  
Author(s):  
Evaldo Favi ◽  
Ajith James ◽  
Carmelo Puliatti ◽  
Phil Whatling ◽  
Mariano Ferraresso ◽  
...  

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