Successful treatment of encapsulating peritoneal sclerosis with immunosuppressive therapy

Am J Kidney Dis. 2008 Feb;51(2):e7-10. doi: 10.1053/j.ajkd.2007.07.036.

Abstract

Encapsulating peritoneal sclerosis is a rare, but potentially lethal, complication of peritoneal dialysis. Treatment of patients with encapsulating peritoneal sclerosis is controversial. Conservative treatment carries a poor outcome, and immunosuppressive drugs are now used frequently. Most commonly, these immunosuppressive regimens include steroids with or without azathioprine or cyclosporine. Mycophenolate mofetil is a reversible DNA synthesis inhibitor that frequently replaces azathioprine in renal transplantation because of its improved immunosuppressive potency and better side-effect profile. We report 3 cases of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients for which an association of prednisone and mycophenolate mofetil significantly modified the evolution of the disease. All 3 patients showed significant improvement within a month and are still alive more than 2 years after the diagnosis of encapsulating peritoneal sclerosis. None experienced a relapse or abdominal symptoms, and body weights are stable. This is the first report of 3 cases of successful treatment of patients with encapsulating peritoneal sclerosis with prednisone and mycophenolate mofetil.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Ascites / etiology
  • Ascitic Fluid / microbiology
  • Candida glabrata / isolation & purification
  • Candidiasis / drug therapy
  • Candidiasis / etiology
  • Female
  • Fibrosis / complications
  • Fibrosis / drug therapy
  • Fibrosis / etiology
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Intestinal Obstruction / etiology
  • Intestine, Small / pathology*
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Diseases / drug therapy*
  • Peritoneal Diseases / etiology*
  • Peritoneal Diseases / mortality
  • Peritoneal Diseases / pathology
  • Peritoneum / pathology*
  • Peritonitis / drug therapy
  • Peritonitis / etiology
  • Prednisone / therapeutic use
  • Sclerosis / complications
  • Sclerosis / drug therapy
  • Sclerosis / etiology
  • Staphylococcus epidermidis / isolation & purification

Substances

  • Anti-Inflammatory Agents
  • Immunosuppressive Agents
  • Mycophenolic Acid
  • Prednisone