Journal Information
Vol. 28. Issue. 1.February 2008
Pages 1-121
Full text access
Chyloperitoneum and amyloidosis
Quiloperitoneo y amiloidosis
Aranzazu Sastre Lópeza, R.. Bernabéu Lafuentea, J. M.. Gascó Companya
a Servicio de Nefrología, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España,
This item has received
Article information
Full Text
Download PDF
El quiloperitoneo es una entidad rara en diálisis peritoneal. Se ha descrito en pacientes diagnosticados de amiloidosis sistémica. Presentamos el caso de una paciente en programa de diálisis peritoneal, con amiloidosis familiar tipo enfermedad de Andrade que cursó con quiloperitoneo intermitente y recidivante.
Palabras clave:
Palabras clave:
Diálisis peritoneal
Palabras clave:
Chyloperitoneum is very infrequent in peritoneal dialysis. It has been described in patients diagnosed of systemic amyloidosis. We present the case of a patient in program of peritoneal dialysis, with familial amyloidosis type Andrade disease that presented intermittent and recidivante chyloperitoneum.
Peritoneal dialysis
Full Text

To the editor:

Chyloperitoneum is a rare condition in patients on peritoneal dialysis.1 It has been reported in patients diagnosed with systemic amyloidosis. We present a patient on peritoneal dialysis, with familial amyloidosis Andrade type with intermittent and recurrent chyloperitoneum.

The patient was a 69 year-old woman who began peritoneal dialysis in April of 2006. She had renal amyloidosis in the setting of familial amyloid polyneuropathy (FAP), which had manifested with nephrotic syndrome.

The clinical picture onset at 64 yearold with hyperestesia of the lower limbs. The electromyography was compatible with mixed polyneuropathy. She had the transthyretin transthyretin (TTR) mutation (Val-30-Met). Rectal biopsy study showed amyloid deposition, and the diagnosis of FAP was confirmed. At presentation, renal function was normal and the proteinuria was negative. She required a pacemaker because of cardiac amyloid infiltration.

Mallorca is the fifth world endemic focus of FAP or Andrade¿s disease,2 a hereditary systemic amyloidosis, with mixed polyneuropathy being the main manifestation. The inheritance is autosomal dominant. The disease is due to a transthyretin mutation, which is synthesized in the liver and forms systemic depositions, which cause the clinical picture.

The diagnosis is made by means of rectal, fat or sural nerve biopsy, that discloses the TTR variant or the DNA mutation.

The only efficacious treatment is liver transplantation.

In January of 2004 proteinuria appeared, which reached nephrotic range. Since April of 2005, the renal function deteriorated progressively, and in February of 2006 a catheter for peritoneal dialysis was placed.

During peritoneal catheter implantation peritoneal lavage was performed and a white fluid was obtained.

Chyloperitoneum is the appearance of a turbid milk-like fluid due to the presence of chylomicrons. Among the causes that can be implicated are: micro-traumas, sometimes during catheter insertion;3 malignant diseases, mainly lymphomas;4 hepatic cirrhosis, acute pancreatitis;5 systemic amyloidosis6 as in the case reported; lymphatic obstruction due to fibrotic adherences of tuberculosis;7 dihydropiridinic calcium channel antagonists;8 and lymphatic vessels malformations.9

During the training period, chyloperitoneum was obtained that attenuated with lavage.

The suspicion of chyloperitoneum arises in the presence of milk-like fluid and the diagnosis is confirmed when chylomicrons are detected, ortriglycerides levels in the peritoneal fluid are higher than those in plasma, and protein value in the peritoneal fluid is higher than half of the protein value in plasma, like in the reported case. Differential diagnosis should be made with conditions accompanied with turbid fluid, normal cellularity and negative cultures.

A expectant attitude was taken. Regular oil was replaced by mediumchain triglycerides (MCT)-containing oil.

Treatment is usually conservative. A protein and carbohydrate rich diet is recommended with low fat content. MTC oils are preferred. The ligation of the thoracic duct can prevent nutritional complications.

Currently the patient presents intermittent and self-limited chyloperitoneum (every 10 days approximately). Nutritional parameters are preserved with daily intake of 2 liters of Nutrineal. The patient is wheel chair-bound due to FAP-associated disability.

Porter J, Wang WM, Olivereira DB. Chylous ascites on CAPD. Nephrol Dial Transplant 6 (9): 659-661, 1991.
Munar-Ques M. Corino Andrade disease. An R Acad Nac Med (Madr); 116 (3): 667- 80, 1999.
Poux JM, Bénévent D, Guiserix J, Le Meur Y, Lagarde C, Leroux-Robert C. Chylous ascites in 12 patients undergoing peritoneal dialysis. Nephrologie 15 (3): 201-5, 1994. [Pubmed]
Bargman JM, Zent R, Ellis P, Auger M, Wilson S. Diagnosis of lymphoma in a CAPD patient by peritoneal fluid cytology. Am J Kidney Dis 23 (5): 747-750, 1994. [Pubmed]
Pérez Fontán M, Pombo F, Soto A, Pérez Fontán FJ, Rodríguez-Carmona A. Chylous ascites associated with acute pancreatitis in a patient undergoing continuous ambulatory peritoneal dialysis. Nephron 63 (4):458-61, 1993. [Pubmed]
Coronel F, Avilés B. Chyloperitoneum in a peritoneal dialysis patient with primary AL amyloidosis. Perit Dial Int 23 (3): 299-301, 2003. [Pubmed]
Huang CH, Chen HS, Chen YM, Tsai TJ. Fibroadhesive form of tuberculous peritonitis: chyloperitoneum in a patient undergoing automated peritoneal dialysis. Nephron 72 (4): 708-11, 1996. [Pubmed]
Yoshimato K, Saima S, Nakamura Y, Nakamaya M, Kobo H, Kawaguchi Y y cols. Dihydropyridine type calcium channel blocker- induced turbid dialysate in patients undergoing peritoneal dialysis. Clin Nephrol 50 (2): 90-93, 1998. [Pubmed]
Unger SW, Chandler JG. Chylous ascites in infant and children. Surgey 93 (3): 455-461, 1993.
Nefrología (English Edition)
Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?