Eosinophilic dialysis peritonitis. Cases report and literature review

Peritoneal dialysis (PD) is a widely used method of renal replacement therapy (RRT) in children with stage 5 chronic kidney disease (CKD). The most common complication of PD and the leading cause of hospitalization for these patients is dialysis peritonitis. The vast majority of cases of dialysis peritonitis are caused by microbial infection of the abdominal cavity and demands antibiotic therapy. Dialysis peritonitis resistant to antibacterial therapy leads to the removal of the peritoneal catheter, to the temporary or permanent transfer of the patient to hemodialysis. However, some cases of dialysis peritonitis not responding to antibiotic therapy are represented by a separate form - eosinophilic peritonitis (EP), in which more than 10% of the dialysate cells are eosinophils, and which requires special approaches to therapy. The article presents three cases of EP in children demonstrating characteristic features of this complication: in two of the three patients, EP appeared after repeated abdominal surgery, eosinophils predominated in the dialysate cell count (68-95%), and blood eosinophilia was observed. In no case, bacteria growth in repeated dialysate cultures was detected. In all patients, EP resolved with corticosteroid therapy. In one case, after stopping EP, bacterial dialysis peritonitis developed. In addition to dialysate culture, differential diagnosis between EP and bacterial peritonitis was carried out by leukocytes count in a stained dialysate smear. The review of publications provides information on the incidence of EP according to foreign researchers, on the pathogenesis, symptoms, diagnostic methods, and therapy of this condition. Idiopathic and secondary EP are considered. Idiopathic EP is facilitated by factors directly related to peritoneal dialysis: peritoneal catheter material, dialysis solution components (including icodextrin), air entering the abdominal cavity when the peritoneal catheter is inserted and exchanges are performed, and mechanical stress of the peritoneum caused by the dialysis solution. Secondary EP may develop with the use of various drugs intraperitoneally or orally, with local or systemic infection (fungal, mycobacterial, parasitic) Timely diagnosis of EP in PD patients prevents long-term “empirical” antibacterial therapy, associated with the risk of fungal peritonitis, unjustified removal of the peritoneal catheter, and maintains PD as the optimal dialysis method in children.

дети, перитонеальный диализ, диализный перитонит, эозинофильный перитонит, children, peritoneal dialysis, dialysis peritonitis, eosinophilic peritonitis

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