Epidemiology
- Acute pleural effusion may occur in some cases
- Incidence: 10% of CAPD patients will develop effusion
- Most cases occur within 4 months of beginning CAPD (one case occurred 10 months later)
Physiology
- Movement of dialysate through diaphragm into pleural space
Diagnosis
- Pleural fluid:
-Appearance:
-pH:
-LDH ratio: low pleural LDH
-Total protein ratio: pleural protein <10g/L
-Glucose: intermediate between that of dialysate and serum
-Cell count/ diff:
CXR/Chest CT patterns:
1) Pleural effusion:
Clinical
- Pleural Effusion (see [[Pleural Effusion-Transudate]]
Treatment
- Closure of diaphragmatic defect:
- Spontaneous closure: occurs in some cases
- Surgical closure: may be required required in some cases if CAPD is to be continued
- Pleurodesis (treatment of choice): pleurodesis, followed by a short period of small-volume intermittent peritoneal dialysis
References
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