Álvaro Vaz

Background:Peritonitis is one of the most common complications of peritoneal dialysis. The most frequent agents have been largely described and studied but unusual microorganisms have only been reported in case reports. Methods: We describe the cases of unusual bacteria causing peritonitis in our peritoneal dialysis patients between 1998 and 2012. Results: In this 15-year period, we have registered 188 peritonitis in 118 patients (0.64 episodes/patient/year). Unusual bacteria were considered all that have caused peritonitis in only one or two instances (12 bacteria in 15 episodes). We have performed antibiogram-based antibiotic therapy in all of them. In two cases catheter removal was necessary and one patient has died in direct relation with the peritonitis. Conclusions: Unusual bacterial agents may cause peritonitis in peritoneal dialysis. They are rare and may present with a broad spectrum of seriousness. Publication of experiences may help guiding therapy and increases scientific evidence

Background: Recurrent ascites is a late manifestation of several diseases, including cancer, cirrhosis, and heart failure, invariably associated with very poor prognosis. Hence, every effort must be aimed at reducing discomfort and side effects of its management. Objective: To evaluate if peritoneal catheters (PCs) are a viable alternative treatment approach in palliative patients who fail medical management of ascites. Design: Case study. Results: We report the case of a terminal patient with cirrhosis and hepatocellular carcinoma who presented refractory ascites despite serial large-volume paracentesis. A Tenckhoff percutaneous catheter was inserted, allowing for ascites' control and with no complications noted. Conclusions: PC placement was successful in controlling the patient's symptoms and ultimately improved comfort and well-being during the final stage of his life. This option should be assessed in selected patients to elevate palliative standards of care.

The residual renal function (RRF) in a peritoneal dialysis (PD) patient is clinically important because it contributes to dialytic adequacy, quality of life and mortality. We present the case of a patient in PD with a marked decrease in RRF. Even after the increase of dialysis, the patient maintained asthenia and anorexia, was prostrate and showed no improvement analytically. The study revealed hypothyroidism, iatrogenic due to the use of amiodarone. After suspension of the drug and replacement with levothyroxine, there was a normalization of thyroid function and recovery of RRF to baseline values. A thyroid dysfunction is associated with several changes in renal function, in most cases reversible after obtaining euthyroid state. The association between thyroid dysfunction and loss of RRF continues to be under-recognized. We should consider monitoring thyroid function annually as routine in this group of patients.

Abstract Churg‐Strauss is a rare syndrome with only a few hundred cases reported in the literature. Overlap with other vasculitic disorders is even more unusual, although some cases have been described. Patients may have several phases of the syndrome over many years, before the development of systemic vasculitis. We report the case of a patient whose clinical and pathological evolution suggests an initial presentation consistent with Churg‐Strauss and a subsequent evolution to Goodpasture disease, a sequential development that had not yet been reported. Recent efforts to classify vasculitis according to clinical and pathological features have been most helpful in guiding diagnosis and therapeutic options, although some clinical cases still represent a challenge.