Thread: Cổ trướng trong suy thận mạn tính lọc máu chu kỳ

Không biết ở các bệnh viện khác thế nào nhưng ở chỗ em tỷ lệ bệnh nhân suy thận mạn tính lọc máu chu kỳ bị tràn dịch ổ bụng cũng không phải ít đâu ạ. Theo em quan sát thấy dịch ổ bụng thường là dịch tự do mức độ nhiều, dịch tiết, tỷ lệ L cao. Protein và Albumin máu bệnh nhân thường giảm nhẹ hoặc vừa nên không tương ứng với mức độ tràn dịch. Cấy khuẩn (-), không phát hiện tế bào ác tính trong dịch... Điều trị đáp ứng rất kém. Tuy nhiên em thấy rất ít tài liệu nói đến vấn đề này. Bác nào có kinh nghiệm có thể chia sẻ với em một chút được không ạ?
Cám ơn các bác quan tâm theo dõi!

Chẳng có kinh nghiệm gì, nhưng tìm được cái này nên em post vào đây tặng bác:

IDIOPATHIC DIALYSIS ASCITES — Patients on maintenance hemodialysis may develop ascites in the absence of a clear underlying cause. This entity, known as idiopathic dialysis ascites, is a diagnosis of exclusion. Associated findings may include volume overload, cachexia, hypoalbuminemia, and malnutrition. The incidence of this complication is declining due to improvement in hemodialysis technology, better control of volume overload, enhanced dialysis dose, and better nutrition.
Pathogenesis — The pathogenesis of idiopathic dialysis ascites is most likely multifactorial, including [80-84]:

• Chronic volume overload with hepatic congestion and increased hepatic vein hydrostatic pressure.
• Changes in the permeability of the peritoneal membrane, as some affected patients previously underwent peritoneal dialysis.
• Impaired lymphatic peritoneal resorption. The rate of lymphatic fluid removal, as demonstrated by lymphatic flow studies, is slower in uremic patients.
• Contributing factors, such as hypoalbuminemia and congestive heart failure.
• Hyperparathyroidism.

Diagnosis — Intensive investigations are usually required to exclude other causes. (See "Initial therapy of ascites in patients with cirrhosis".) In addition to the proper clinical setting, diagnostic criteria for idiopathic dialysis ascites includes ascitic fluid with the following characteristics:

• Straw-colored appearance
• High protein content (3 to 6 gm/dL)
• A leukocyte count ranging from 25 to 1600 cells/mm3

As part of the evaluation, a laparoscopic examination is usually required to eliminate various possibilities and to perform appropriate biopsies for histologic examinations and cultures.
Treatment — Initial strategies to control ascites include salt and fluid restriction, aggressive fluid removal by ultrafiltration, intermittent paracentesis, and/or better nutritional intake [85]. However, hypotension may be a limiting factor in some patients.
If these initial measures fail to provide substantial benefit, switching to CAPD has been shown to reduce the severity of ascites and to improve nutritional status. In addition, in some studies, placement of a peritoneovenous shunt (Denver or LeVeen shunt) has reportedly resulted in hemodynamic stability, reduction of ascites, and improvement of nutritional status [86]. However, major complications of peritoneovenous shunt include infections and malfunction. As a result, careful follow up of these patients and monitoring is usually required. (See "Peritoneovenous shunt for ascites and hepatorenal syndrome".)
Renal transplantation appears to be the definitive treatment of these patients as complete resolution of ascites has been reported to occur within six weeks of transplantation in almost all patients [87,88]. Recurrence of ascites has been observed following graft failure [86,87]. (See"Treatment of diuretic-resistant ascites in patients with cirrhosis".)
Prognosis — The prognosis of idiopathic dialysis ascites is poor. Approximately 45 percent of patients die within 15 months of diagnosis [89,90].