| Theme |
Complications of Respiratory Organs in Dialysis Patients |
| Title |
Mediastinitis and pleuritis in hemodialysis patient |
| Author |
Takeshi Miyahira |
Department of Nephrology, Okinawa Prefectural Hokubu Hospital |
| Author |
Toshihiko Ohama |
Department of Nephrology, Okinawa Prefectural Hokubu Hospital |
| Author |
Hideki Takeda |
Department of Nephrology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center |
| Author |
Doki Chyou |
Department of Nephrology, Okinawa Prefectural Hokubu Hospital |
| Author |
Kazushi Kinjyo |
Department of Nephrology, Okinawa Prefectural Hokubu Hospital |
| Author |
Kunihiro Shimoji |
Department of Nephrology, Okinawa Prefectural Chubu Hospital |
| [ Summary ] |
Many causes of pleural effusion should be considered in patients receiving hemodialysis. In general, pleural effusion is characterized as either a transudate or an exudate. Thoracentesis make it possible to analyze fluids for pH levels, proteins, glucose, LDH, smear (Gram stain, AFB stain) and cell count differentials. Cultures for aerobic or anaerobic bacteria, mycobacterium tuberculosis, as well as cytologic examinations should be included in fluid studies. Bloody exudated fluid, with lymphocytic predominance, indicates uremic pleuritis, tubercular pleurisy or malignancy, and may require a pleural biopsy. Although the prognosis for uremic pleuritis is generally good, it can become critical and requires caution. Tuberculous pleurisy should be diagnosed comprehensively based on the results of pleural fluid cultures, AFB staining, ADA and pleural biopsies. Even though no evidence of tuberculous pleurisy may be obtained, empirical treatment should be considered if suspected clinically. |