Chyloperitoneum: Is Secondary Amyloidosis a Possible Cause?

Sujan, S. Sujan; Ruiz, S. Ros; Cobelo, Carmen; Campos, Carla

doi:10.1177/089686080902900520

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…3 We identified 11 cases of proteinuric glomerulonephritis associated with chylous ascites in the medical literature, of which only 4 cases were recognized as focal segmental glomerulosclerosis ( Table 2), and all were associated with severe hypoalbuminemia, with a serum albumin < 2.0 g/dL ( Table 2). [2][3][4][5][6][7][8][9][10][11][12] Lymphatic obstruction and abnormal lymphatic drainage has been described in both nephrotic and nonnephrotic patients with chylous ascites. 1,2 Our nephrotic patient had no abnormal lymph leakage or obstruction, as demonstrated by normal lymphoscintigraphy (Figure 3A).…”

Section: Diagnosismentioning

confidence: 99%

Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis

McMahon

Moran

Sperati

et al. 2016

The American Journal of Medicine

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A 67-year-old Sub-Saharan African man presented to an outside institution with progressive, painless abdominal distention, anorexia, leg swelling, and dyspnea on exertion. He had not seen a physician in many years. He denied alcohol use, intravenous drug use, or any recent surgery. He was referred to our institution for a second opinion. On physical examination, he was alert and orientated. His temperature, pulse, blood pressure, and room air oxygen saturation were 36.1 C, 82 beats per minute, 115/73 mm Hg, and 99%, respectively. He had no purpura and no stigmata of chronic liver disease. He had 3þ pitting edema to the hips and a distended nontense abdomen with shifting dullness. ASSESSMENT Laboratory studies revealed hemoglobin of 13.9 g/dL (ref: 13.9-16.3 g/L), platelet count of 101 K/cu mm (ref: 150-350 K/cu mm), and creatinine of 6.8 mg/dL (ref: 0.6-1.3 mg/dL) (no prior baseline known) corresponding to an estimated glomerular filtration rate (eGFR) of 10 mL/min/1.73m 2 and a serum albumin of 1.4 g/L (ref: 3.5-5.3g/dL). Urinalysis revealed 3þ protein. Urine microscopy demonstrated fatty casts, fine granular casts, and oval fat bodies, but no red or white cell casts. A 24-hour urine collection noted 16.1 g of proteinuria (ref: 0-100 mg/24 h). He had normal liver Funding: None.

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Section: Diagnosismentioning

confidence: 99%

Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis

McMahon

Moran

Sperati

et al. 2016

The American Journal of Medicine

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“…In 1993, Yoshimoto and colleagues reported manidipine-induced turbid peritoneal dialysate with mean dialysate triglyceride levels of 20 ± 9 mg/dL (3). Since then, several reports have been published, but most have been related to calcium channel blockers (4)(5)(6). Here, we present the first case report of chyloperitoneum in a PD patient induced by the direct renin inhibitor aliskiren.…”

Section: Aliskiren-induced Chyloperitoneum In a Patient On Peritoneal Dialysismentioning

confidence: 99%

Cloudy Peritoneal Fluid Attributable to Non-Dihydropyridine Calcium Channel Blocker

et al. 2012

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Editor:A 55-year-old man with hypertension, coronary artery disease, and end-stage renal disease was initiated on automated peritoneal dialysis with 2.5% Dianeal solution [Baxter (India) Private, Haryana, India] 14 days after Tenckhoff catheter placement. On day 0 of initiation, the peritoneal effluent was cloudy. Newspaper print was not visible through the effluent (Figure 1). The patient had no complaints of abdominal pain, fever, loose stools, or vomiting. No fibrin clots were evident, and there were no cells in the effluent. Gram stain, Ziehl-Neelsen stain, and KOH mount of the effluent were negative. Cultures for bacteria and fungi were sterile.The effluent remained cloudy for the next few days, but the patient had no symptoms. There were still no cells on repeat examination, and repeat staining and cultures of the effluent were also negative. The patient's pulse was 78 bpm and his blood pressure was 130/80 mmHg. A clinical examination, including abdominal exam, was unremarkable. There were no clinical features suggestive of acute pancreatitis, solid-organ malignancy, or lymphoma.Effluent triglycerides were measured. The levels were high at 54 mg/dL, 61 mg/dL, and 52 mg/dL on 3 consecutive days. Serum triglycerides were 134 mg/dL. Serum and effluent amylase levels were 12 U/dL and 10 U/dL respectively. In other investigations, serum creatinine was 8.8 mg/dL; blood urea nitrogen, 213 mg/dL; hemoglobin, 9.8 g/dL; and 24-hour urine protein, 230 mg. Contrast-enhanced computed tomography imaging of the abdomen revealed a normal pancreas. Effluent was also negative for malignant cells on repeat examination.The surgeon reported that the catheter insertion had been atraumatic. The patient's medications during this phase of cloudy peritoneal fluid were sevelamer carbonate, injection calcitriol, diltiazem, isosorbide mononitrate, aspirin, and vitamins.Diltiazem, although not a dihydropyridine calcium channel blocker, was stopped. The next day, the effluent became translucent. There were no cells in the effluent. Effluent triglycerides fell to a normal level of 1.0 mg/ dL. After 3 days, the diltiazem was added back to the patient's medications. The effluent became cloudy again, and effluent triglycerides were now 55 mg/dL.Cloudy peritoneal fluid is not always infection (1). An absence of cells excludes infection, intra-or juxta-peritoneal inflammation, allergic reaction to constituents of the dialysis system, air, and pharmaceuticals. Our patient

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“…systemic lupus with mesenteric involvement, 74 nephrotic syndrome,75,76 sarcoidosis, 77 retroperitoneal fibrosis,78 and Whipple's…”

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confidence: 99%

When the color of peritoneal dialysis effluent can be used as a diagnostic tool

Dossin

Goffin

2018

Seminars in Dialysis

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Peritoneal dialysis (PD) effluent is normally transparent. A change in its appearance may be the first indication of an intra- or extraperitoneal abnormality which may or may not be related to the peritoneal dialysis technique itself. What diagnosis should be considered when PD effluent turns on red, orange, cloudy, milky white, green, yellow, purple or black in color? After review of the literature, we propose a differential diagnosis, as well as some management recommendations, for specific abnormal color presentations of the PD effluent.

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Chyloperitoneum: Is Secondary Amyloidosis a Possible Cause?

Abstract: Tallman A. Biodiversity and systematics of basidiomycetous yeasts as determined by large-subunit rDNA D1/D2 domain sequence analysis.

Cited by 3 publications

References 9 publications

Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis

Renal Thrombotic Microangiopathy, Podocytopathy, and Chylous Ascites: A Hard-Nosed Diagnosis

Cloudy Peritoneal Fluid Attributable to Non-Dihydropyridine Calcium Channel Blocker

When the color of peritoneal dialysis effluent can be used as a diagnostic tool

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