PERITONEAL DIALYSIS IN A PATIENT WITH RIGHT HEMIPARESIS, LUPUS NEPHRITIS, SIGNIFICANT INSUFFICIENCY OF ARTERIES OF AORTIC ARCH AND CELIAC DISEASE

Peritonejska dijaliza (PD) je metoda izbora kod bolesnika u kojih je otežano kreiranje krvožilnog pristupa za hemodijalizu. Tridesetosmogodišnja bolesnica javila se u našu Ustanovu u fazi terminalnog bubrežnog zatajenja nepoznate geneze zbog kreiranja AV fistule. Zbog preboljelog moždanog udara 1993. godine, bolesnici je zaostala desnostrana hemipareza s kontrakturom šake i epilepsija. Učinjenom obradom dijagnosticirali smo lupus nefritis s fosfolipidnim sindromom, okluziju trunkusa brahiocefalikusa, zajedničkih karotidnih arterija, te lijeve arterije subklavije. Također smo dokazali glutensku enteropatiju i značajnu anemiju. Kreiranje AV fistule na ruci nije bilo moguće, kao niti asistirana peritonijska dijaliza, a zbog desnostrane hemipareze i kontrakture desne šake bila je upitna mogućnost samostalnog provođenja peritonejskih izmjena. Unatoč tom hendikepu bolesnica je, uz jaku motivaciju, uspjela samostalno savladati tehniku peritonejske dijalize. Iako je procijenjeno da ima visok operativni rizik, zahvat postavljanja peritonejskog katetera je prošao bez komplikacija. Zbog komorbiditeta, u prvom redu zbog značajnih stenoza i okluzija arterija luka aorte, odustalo se od transplantacije bubrega. Bolesnica već petnaest mjeseci samostalno provodi peritonejsku dijalizu bez infektivnih komplikacija, osjeća se dobro, zadovoljna je kvalitetom života, sekvele kronične bubrežne bolesti zadovoljavajuće su kontrolirane, sustavni eritemski lupus je, uz malu dozu kortikosteroida, u fazi mirovanja, pothranjenost je korigirana, ali je i dalje prisutna hipoalbuminemija.Peritoneal dialysis (Pd) is a method of choice in patients in whom there are difficulties concerning creation of av fistula. a 38-year old female patient came to our hospital because of a need of making an av fistula. she had end-stage renal insufficiency of unknown origin. she had a right hemiparesis with a contracture of the right fist and epilepsy because of the stroke she suffered in 1993. after doing the diagnostics, we have found that patient had lupus nephritis, occlusion of brachiocephalic trunk, right and left common carotid artery and left subclavian artery. We also diagnosed celiac disease and a significant anemia. it was not possible to form an av fistula, as it was not possible to do an assisted Pd. because of the right hemiparesis and contracture of the right fist, the possibility of performing Pd independently was questionable. despite the handicap, the patient had strong motivation and she managed to master the technique of Pd independently. even though it was estimated that she had a high risk score for applying anesthesia (asa iv), the insertion of the peritoneal catheter went without complications. because of the comorbidity, especially because of the significant stenosis and occlusions of the arteries of aortic arch, the kidney transplantation will not be performed. in the last fifteen months, the patient is performing Pd independently, without any infectious complications, she is feeling well and is satisfied with the quality of her life. the consequences of the renal insufficiency are under control, systemic lupus erythematosus is, with a low dose of corticosteroids, in a steady state, malnutrition is corrected, but there is still hypoalbuminemia noted