array:21 [
  "pii" => "X2013251412002213"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
  "estado" => "S300"
  "fechaPublicacion" => "2012-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:829-34"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5128
    "formatos" => array:3 [
      "EPUB" => 291
      "HTML" => 4168
      "PDF" => 669
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512002216"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
      "estado" => "S300"
      "fechaPublicacion" => "2012-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:829-34"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6062
        "formatos" => array:3 [
          "EPUB" => 312
          "HTML" => 5075
          "PDF" => 675
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Éxito en caso clínico de esclerosis peritoneal encapsulante: tratamiento quirúrgico mediante enterólisis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => 0
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "829"
            "paginaFinal" => "834"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis ¿ surgical management using enterolysis"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => " Diálise Peritoneal dos C.H.U.C, Patrícia Neto"
            "autores" => array:2 [
              0 => array:1 [
                "apellidos" => "Diálise Peritoneal dos C.H.U.C"
              ]
              1 => array:2 [
                "nombre" => "Patrícia"
                "apellidos" => "Neto"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412002213"
          "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002216?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002216/v0_201502091339/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412002190"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Oct.11731"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:835-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4158
      "formatos" => array:3 [
        "EPUB" => 288
        "HTML" => 3332
        "PDF" => 538
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "About the discrepancies between consensus documents, clinical practice guidelines, and legal regulations in the treatment of type 2 diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "835"
          "paginaFinal" => "837"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A propósito de las discrepancias entre documentos de consenso, guías de práctica clínica y normativa legal en el tratamiento de la diabetes tipo 2"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto Martínez-Castelao, José L. Górriz, Eva Sola, Carlos Morillas, Ana Jover, Francisco Coronel, Juan Navarro-González, Fernando de Álvaro"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Martínez-Castelao"
            ]
            1 => array:2 [
              "nombre" => "José L."
              "apellidos" => "Górriz"
            ]
            2 => array:2 [
              "nombre" => "Eva"
              "apellidos" => "Sola"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Morillas"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Jover"
            ]
            5 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Coronel"
            ]
            6 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Navarro-González"
            ]
            7 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "de Álvaro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002193"
        "doi" => "10.3265/Nefrologia.pre2012.Oct.11731"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002193?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002190?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002190/v0_201502091603/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412002221"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:824-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6226
      "formatos" => array:3 [
        "EPUB" => 319
        "HTML" => 5222
        "PDF" => 685
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "824"
          "paginaFinal" => "828"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
              "Alto" => 1035
              "Ancho" => 2114
              "Tamanyo" => 340967
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Evolution of renal function"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Angel Manuel Sevillano Prieto, Ángel M. Sevillano-Prieto, Eduardo Hernández Martínez, Eduardo Hernández-Martínez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, María Molina-Gómez, Eduardo Gutiérrez Martínez, Eduardo Gutiérrez-Martínez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester González-Monte, Manuel Praga Terente, Manuel Praga-Terente"
          "autores" => array:16 [
            0 => array:2 [
              "nombre" => "Angel Manuel"
              "apellidos" => "Sevillano Prieto"
            ]
            1 => array:2 [
              "nombre" => "Ángel M."
              "apellidos" => "Sevillano-Prieto"
            ]
            2 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Hernández Martínez"
            ]
            3 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Hernández-Martínez"
            ]
            4 => array:2 [
              "nombre" => "Jara"
              "apellidos" => "Caro Espada"
            ]
            5 => array:2 [
              "nombre" => "Jara"
              "apellidos" => "Caro-Espada"
            ]
            6 => array:2 [
              "nombre" => "Maria"
              "apellidos" => "Molina Gomez"
            ]
            7 => array:2 [
              "nombre" => "María"
              "apellidos" => "Molina-Gómez"
            ]
            8 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Gutiérrez Martínez"
            ]
            9 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Gutiérrez-Martínez"
            ]
            10 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Morales Ruiz"
            ]
            11 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Morales-Ruiz"
            ]
            12 => array:2 [
              "nombre" => "Ester"
              "apellidos" => "Gonzalez Monte"
            ]
            13 => array:2 [
              "nombre" => "Ester"
              "apellidos" => "González-Monte"
            ]
            14 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Praga Terente"
            ]
            15 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Praga-Terente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002224"
        "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002224?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002221?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis ' surgical management using enterolysis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "829"
        "paginaFinal" => "834"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => " Diálise Peritoneal dos C.H.U.C, Patrícia Neto"
        "autores" => array:2 [
          0 => array:1 [
            "apellidos" => "Diálise Peritoneal dos C.H.U.C"
          ]
          1 => array:4 [
            "nombre" => "Patrícia"
            "apellidos" => "Neto"
            "email" => array:1 [
              0 => "patriciaaires3@sapo.pt"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Nefrologia, Centro Hospitalar e Universitário de Coimbra,   Portugal, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#201;xito en caso cl&#237;nico de esclerosis peritoneal encapsulante&#58; tratamiento quir&#250;rgico mediante enter&#243;lisis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
            "Alto" => 771
            "Ancho" => 2172
            "Tamanyo" => 551125
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Potential biomarkers for monitoring membrane injury"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Changes to peritoneal membrane function over time result in the development of ultrafiltration failure in a proportion of peritoneal dialysis &#40;PD&#41; patients and pose a risk for the rarer condition of encapsulating peritoneal sclerosis&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis &#40;EPS&#41; is a rare complication of peritoneal dialysis &#40;PD&#41;&#44; but carries significant morbidity and high mortality of approximately 50&#37;&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Although EPS can be found in different settings&#44; the condition is most frequently seen in patients treated with PD&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">The first cases of EPS in PD patients were reported by Gandhi et al&#46; and Denis et al&#46; in 1980&#46;</p><p class="elsevierStylePara">The multiplicity of suspected etiologies and the its unknown pathogenesis are reflected in the variety of terms that have been used indiscriminately and interchangeably to describe this complication&#44; such as peritoneal fibrosis&#47;peritoneal sclerosis&#47;sclerotic thickening of the peritoneal membrane&#47;sclerotic obstructive peritonitis&#44; calcifying peritonitis&#44; abdominal cocoon and sclerosing peritonitis and sclerosing encapsulating peritonitis&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In 2001 an Ad Hoc committee of the International Society for Peritoneal Dialysis on ultrafiltration management in PD changed the name of the syndrome to encapsulating peritoneal sclerosis &#40;EPS&#41;&#44; which is more descriptive of the morphologic changes&#44; because findings of acute inflammation and peritonitis component is still absent in developed syndrome&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is characterized by partial or diffuse bowel obstruction&#44; accompanied by marked sclerotic thickening of the peritoneal membrane&#46; The clinical features vary&#44; but they frequently include abdominal pain&#44; nausea&#44; vomiting&#44; weight loss&#44; low-grade fever&#44; hemorrhagic effluent&#44; ultrafiltration failure&#44; ascites and resistance to recombinant human erythropoietin&#46;<span class="elsevierStyleSup">3</span> The development is insidious and probably starts with sterile visceral peritoneal inflammation with neovascularisation&#44; followed by massive deposition of fibrous scar tissue that encases part or the entire bowel&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Longitudinal and cross-sectional studies of peritoneal membrane function with duration of PD have identified that at least two processes seem to be occurring&#46; The rate of small-solutes transport tends to increase with duration on PD reflects early change occurred in peritoneal membrane&#46; The second change with time on treatment occurs in only proportion of patients is a reduction in the capacity of the membrane&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Peritoneal sclerosis is generally recognized as a critical component of EPS&#46; However&#44; the onset of EPS does not result solely from the natural progression of peritoneal sclerosis&#46; A &#8220;second hit&#8221; event&#44; such bacterial peritonitis&#44; abdominal bleeding&#44; or abdominal surgery may be needed to trigger the onset of EPS in the face of advanced peritoneal sclerosis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">With the peritoneal membrane&#44; the epithelial to mesenchymal transition &#40;EMT&#41; is one of the earliest histologic changes in the peritoneum and is a critical step in the development of an abnormal membrane &#40;Scheme 1&#41;&#46; There may be more than on stimulus for EMT&#59; candidates include transforming growth factor &#8211;&#946; &#40;TGF-&#946;&#41;&#44; angiotensin II&#44; fibroblast growth factor&#44; and connective tissue growth factor &#40;CTGF&#41;&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">A number of potential mediators have been postulated in the progressive injury associated with membrane damage &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">The potential to use these mediators as biomarkers is still under investigation&#44; although with-in and between &#8211;patient variability is high and it may help be patterns rather than absolute values that will help the clinician in decision making&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">According with ISPD &#40;International Society for Peritoneal Dialysis&#41; Statement&#44; the tentative diagnosis is made on the basis of a combination of bowel obstruction and features of encapsulation due fibrosis&#46; Laparotomy is the only way to make a definitive diagnosis but usually not done as it can be associated considerable morbidity and mortality&#46;<span class="elsevierStyleSup">5</span> The steps for the diagnosis of EPS are exposed on Table 2&#46;</p><p class="elsevierStylePara">Medical and surgical management of EPS remains unsupported by randomized trials&#46; The role of medical therapies and the timing of surgery are poorly defined&#46;</p><p class="elsevierStylePara">The clinical course of EPS is very variable&#46; Some patients progress rapidly to complete bowel encapsulation and obstruction in few weeks&#44; however others can have a course relatively benign&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DESCRIPTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We report the clinical case of a forty-one years old woman suffering of chronic kidney disease in stage 5 secondary to chronic lithiasic pielonephritis&#46; She started hemodialysis in April 2001&#46; In May of 2002 she received a living donor kidney allograft from her mother and unfortunately she quickly lost it&#44; in consequence of unsolved kinking of the renal artery&#46; In December 2003 she restarted hemodialysis and by personal choice she was evaluated to peritoneal dialysis in consult&#46;</p><p class="elsevierStylePara">In January 2004&#44; she was submitted to implantation of the PD catheter and 4 weeks&#160;after she began this modality&#46; The first peritoneal equilibration test revealed a high average transporter and she started automated PD &#40;Nightly Tidal PD&#41;&#46; During the first 3 years she used hypertonic PD solutions &#40;3&#44;86&#37; glucose&#41; to improve fluid balance and control blood pressure&#44; because icodextrine PD solutions were not available&#46; Despite of this&#44; she was presenting a good peritoneal dialysis adequacy and ultrafiltration membrane capacity&#46;</p><p class="elsevierStylePara">During the first years of PD 2 episodes of infection of the extern orifice exit were registered &#40;unknown germen&#41;&#44; and in the fourth year she had a haemoperitoneum &#40;it was excluded infectious and gynecological causes&#41; accompanied by ultrafiltration failure and her peritoneal membrane transporter status changed to high transporter&#46; In this way&#44; it was introduced 7&#44;5&#37; icodextrine PD solutions&#44; that was associated with increased membrane ultrafiltration &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">In May 2009&#44; she was admitted for a peritonitis diagnosis &#40;abdominal pain and cloudy effluent with a WBC count of 6000&#47;mm<span class="elsevierStyleSup">3</span> and 80&#37; neutrophils&#41;&#46;</p><p class="elsevierStylePara">She began an empiric antibiotic scheme with intermittently intraperitoneal vancomycin &#40;2g every 5 days&#41; and intraperitoneal ceftazidime &#40;1g daily&#41;&#46;</p><p class="elsevierStylePara">On day after&#44; she developed sepsis and were prescribed intravenous antibiotics &#40;meropenem 500mg&#47;day and vancomycin 500mg&#47;three times a week&#41;&#46;</p><p class="elsevierStylePara">The peritoneal fluid culture revealed a methicillin - sensitive&#160;<span class="elsevierStyleItalic">Staphylococcus aureus</span>&#160;that led to addition of rifampin<span class="elsevierStyleItalic">&#160;</span><span class="elsevierStyleItalic">per os</span><span class="elsevierStyleItalic">&#160;</span>&#40;600mg&#47;day&#41;&#46;</p><p class="elsevierStylePara">On the fifth day&#44; the poor clinical evolution led to the diagnosis of refractory peritonitis and peritoneal catheter removal and she was transferred to hemodialysis&#46;<span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara">In spite of this&#44; she maintained abdominal pain and distension&#44; vomiting&#44; diarrhea&#44; severe protein malnutrition and emaciation&#46; The radiological evaluation with computed tomography showed bowel wall thickening and enhancement&#44; focal peritoneal calcification&#44; bowel dilatation and loculated ascites &#40;Figure 2 and Figure 3&#41;&#46;</p><p class="elsevierStylePara">The laboratory findings reflected systemic inflammation &#40;elevated reactive C protein&#41; and electrolytes disturbances &#40;particularly hypokalaemia&#41;&#46;</p><p class="elsevierStylePara">In face of&#44; the encapsulating peritonitis sclerosis diagnostic hypothesis was the more probable&#44; nevertheless the absence of pathological confirmation&#46;</p><p class="elsevierStylePara">In spite of the lack of consensus about pharmacological treatment we prescribed oral prednisone 20mg&#47;day and tamoxifen &#40;10mg&#47;day&#41; with institution of parenteral total nutrition&#46;</p><p class="elsevierStylePara">After more than one month of hospitalization and symptom improvement she was discharged to home and extrahospitalar hemodialysis centre&#46; On discharge date&#44; her nutrition was composed by fluid diet and parenteral nutrition during hemodialysis session&#46;</p><p class="elsevierStylePara">In December 2009&#44; she presented with severe malnutrition &#40;Mass Index Body of 13&#44;6kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; feeding intolerance and uncontrollable vomiting&#46; She had discontinued the tamoxifen by gastrointestinal intolerance&#46;</p><p class="elsevierStylePara">She was readmitted to the Hospital&#44; submitted once again&#44; to an Abdominal Computed Tomography&#44; which showed similar findings to previous ones&#44; with larger areas of loculated ascites &#40;Figure 4 and Figure 5&#41;&#46;</p><p class="elsevierStylePara">Two weeks after admission&#44; she was submitted to surgical management with enterolysis conducted by an experient Surgeon&#46; After this procedure&#44; she began solid diet with progressive tolerance without abdominal pain&#46;</p><p class="elsevierStylePara">She was discharged and her convalescence was short and without intercurrences&#46;</p><p class="elsevierStylePara">In December 2011&#44; she received an allograft from a deceased donor kidney allograft&#44; which took place without major complications&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This is a successful clinical case of EPS&#44; which is a poor prognostic entity&#46;</p><p class="elsevierStylePara">In this case&#44; we found factors that seem implicated in the development of EPS&#59; that were&#58; First&#44; the duration of PD &#40;5 years&#41;&#59; second&#44; the chronic use of &#8220;bioincompatibles&#8221; PD solutions&#46;</p><p class="elsevierStylePara">The treatment of this entity implies supportive therapy to control the ileus &#40;aggressive nutritional support&#41;&#44; medical therapy &#40;anti-fibrotic and anti-inflammatory drugs&#41; and surgical interventional &#40;partial or complete enterolysis without enterectomy&#41;&#46;</p><p class="elsevierStylePara">The support care is the first step because the bowel obstruction causes intense malnutrition that implies early nutritional support with either total parenteral &#40;TPN&#41; or enteral nutrition<span class="elsevierStyleSup">5&#44;6</span> and often time requires long-term nasogastric tube placement&#46; In severely malnourished patients there is a role for TPN for 7 to 10 days before planned surgery&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">There have been no controlled trials of corticosteroid therapy in EPS patients&#46; The timing of steroid use may at least partly explain variations in observed efficacy because corticosteroids would not be expected to treat established fibrosis&#46;</p><p class="elsevierStylePara">Tamoxifen has been used as an antifibrotic in retroperitoneal fibrosis&#46; It is a selective oestrogen receptor modulator &#40;SERM&#41;&#44; predominantly used in the treatment the breast cancer&#46; Another characteristic of tamoxifen is itself activity on the profibrotic cytocine TGF-&#946; and has been show to be effective in fibrotic diseases&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">The efficacy of tamoxifen in EPS has been described only in case series&#46; Korte et al&#46; make the largest study about efficacy of tamoxifen in EPS&#44; from The Netherlands&#44; between 1996 and 2007&#46; Tamoxifen had been given to 24 patients and not used in 39 patients&#46; The duration of tamoxifen use was for 4 weeks or more&#46; Mortality in the tamoxifen group was 45&#44;8&#37; as compared with 74&#44;4&#37; in the untreated group &#40;p 0&#46;03&#41;&#44; and multivariate Cox regression analysis confirmed a trend to better survival in the treated group&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">The surgical management should follow a trial of medical therapy&#46; The time of surgery is thus as important and as yet unresolved factor&#46; Mortality rate after surgery in the published literature has suffered variations&#59; this reflects an increasing surgical expertise&#46; The first experience suggested high mortality when enterectomy and bowel anastomosis was required&#44; but recent reported improved outcome using enterolysis&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Talking about prevention of EPS implies to know that the duration on PD is the only consistent risk factor&#46; There are no prospective data demonstrating any benefit of preemptively switching long-term PD patients to HD&#46; The incidence of EPS increases particularly after 5 or more years of the treatment&#44; however the majority of long-term PD patients will not develop EPS&#46;<span class="elsevierStyleSup">5</span> When considering switching patients from long-term PD to HD preemptively&#44; it may appropriate to select those patients with potentially adverse features such ultrafiltration failure or low ultrafiltration capacity and requirement for high glucose containing concentration dialysate and recurrent episodes of peritonitis&#46; The usually prescription and utilization of &#8220;biocompatible&#8221; PD fluids requires future randomized trials to support these practices&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31058&#95;en&#95;t111532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31058_en_t111532_copia.jpg" alt="Potential biomarkers for monitoring membrane injury"></img></a></p><p class="elsevierStylePara">Table 1&#46; Potential biomarkers for monitoring membrane injury</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31059&#95;en&#95;t211532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31059_en_t211532_copia.jpg" alt="Diagnosis of encapsulating peritoneal sclerosis"></img></a></p><p class="elsevierStylePara">Table 2&#46; Diagnosis of encapsulating peritoneal sclerosis</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31061&#95;en&#95;f211532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31061_en_f211532_copia.jpg" alt="Bowel dilatation&#44; diffuse peritoneal enhancement"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Bowel dilatation&#44; diffuse peritoneal enhancement</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31062&#95;en&#95;f311532&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31062_en_f311532.jpg" alt="Focal peritoneal calcification"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Focal peritoneal calcification</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31063&#95;en&#95;f411532&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31063_en_f411532.jpg" alt="Diffuse peritoneal enhancement"></img></a></p><p class="elsevierStylePara">Figure 4&#46; Diffuse peritoneal enhancement</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31064&#95;en&#95;f511532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31064_en_f511532_copia.jpg" alt="Loculated ascites"></img></a></p><p class="elsevierStylePara">Figure 5&#46; Loculated ascites</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31065&#95;en&#95;f111532&#95;copia&#95;copy1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31065_en_f111532_copia_copy1.jpg" alt="Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity</p>"
    "pdfFichero" => "P1-E544-S3766-A11532-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437197"
          "palabras" => array:1 [
            0 => "Di&#225;lisis peritoneal"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437199"
          "palabras" => array:1 [
            0 => "Esclerosis peritoneal encapsulante"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437201"
          "palabras" => array:1 [
            0 => "Enterolisis"
          ]
        ]
      ]
      "en" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437198"
          "palabras" => array:1 [
            0 => "Peritoneal dialysis"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437200"
          "palabras" => array:1 [
            0 => "Encapsulating peritoneal sclerosis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437202"
          "palabras" => array:1 [
            0 => "Enterolysis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">La esclerosis peritoneal encapsulante &#40;EPE&#41; es una complicaci&#243;n poco com&#250;n&#44; pero grave&#44; de la di&#225;lisis peritoneal&#46; La tasa de incidencia var&#237;a entre el 0&#44;5 y el 4&#44;4 &#37;&#46; Esta complicaci&#243;n est&#225; asociada a tasas significativas de morbilidad y mortalidad&#46; El diagn&#243;stico requiere la presencia de manifestaciones cl&#237;nicas de obstrucci&#243;n intestinal o funci&#243;n gastrointestinal alterada con signos patol&#243;gicos y radiol&#243;gicos de encapsulamiento intestinal&#46; El mecanismo patog&#233;nico exacto de la EPE sigue siendo desconocido&#44; aunque s&#237; que se asocia firmemente con la duraci&#243;n de la di&#225;lisis peritoneal&#46; Presentamos un caso cl&#237;nico de EPE y analizamos las manifestaciones cl&#237;nicas&#44; diagn&#243;stico&#44; tratamiento&#44; pron&#243;stico y prevenci&#243;n&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">The encapsulating peritoneal sclerosis is a rare but serious complication of peritoneal dialysis&#46; The incident rate varies between 0&#46;5 to 4&#46;4&#37;&#46; This entity is associated with significant morbidity and mortality&#46; The diagnosis requires the presence of clinical features of intestinal obstruction or disturbed gastrointestinal function with pathological and radiological evidence of bowel encapsulation&#46; The exact pathogenic mechanism of EPS remains unknown&#44; although it&#8217;s strongest associated with duration of peritoneal dialysis&#46; We present a clinical case of EPS and discuss the clinical manifestations&#44; diagnosis&#44; treatment&#44; prognosis and prevention&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
            "Alto" => 771
            "Ancho" => 2172
            "Tamanyo" => 551125
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Potential biomarkers for monitoring membrane injury"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31059_en_t211532_copia.jpg"
            "Alto" => 1739
            "Ancho" => 2185
            "Tamanyo" => 901933
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Diagnosis of encapsulating peritoneal sclerosis"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31061_en_f211532_copia.jpg"
            "Alto" => 649
            "Ancho" => 1012
            "Tamanyo" => 233185
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Bowel dilatation&#44; diffuse peritoneal enhancement"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31062_en_f311532.jpg"
            "Alto" => 602
            "Ancho" => 1010
            "Tamanyo" => 223856
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Focal peritoneal calcification"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Fig. 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31063_en_f411532.jpg"
            "Alto" => 668
            "Ancho" => 1010
            "Tamanyo" => 265626
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Diffuse peritoneal enhancement"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Fig. 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31064_en_f511532_copia.jpg"
            "Alto" => 743
            "Ancho" => 1012
            "Tamanyo" => 295540
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Loculated ascites"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31065_en_f111532_copia_copy1.jpg"
            "Alto" => 936
            "Ancho" => 2105
            "Tamanyo" => 334670
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Davies SJ, Mushahar L, Lambie M. Determinants of peritoneal membrane function over time. Semin Nephrol 2011;31:172-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21439431" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Goodlad C, Brown EA. Encapsulating peritoneal sclerosis: what have we learned? Semin Nephrol 2011;31:183-98. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21439432" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kawaguchi Y, Kawanishi H, Mujais S, Topley N,\u{A0}Oreopoulos DG. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20[suppl 4]:S43-S55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11098928" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861013002806"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Saito A. Peritoneal dialysis in Japan: the issue of encapsulating peritoneal sclerosis and futures challenges. Perit Dial Int 2005;25 Suppl 4:S77-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16300276" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Brown EA, Biesen WV, Finkelstein FO, Hurst H,\u{A0}Johnson DW,\u{A0}Kawanishi H, et al.;\u{A0}ISPD Working Party. Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis: position paper for ISPD. Perit Dial Int 2009;29:595-600. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19910558" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Woodrow G, Augustine T, Brown EA, Cowling M, El-Sherbini N, Hurst H, et al. UK encapsulating peritoneal sclerosis clinical practises guidelines, July 2009. Available at: http://www.renal.org/Libraries/Other_Guidlines/Encapsulating_Peritoneal_Sclerosis_guidelines_UK_EPS_Group_Final_July_2009.sflb.ashx."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 1991;325:525-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1906987" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Van Bommel EF, Hendriksz TR, Huiskes AW, Zeegers AG. Brief communication: tamoxifen therapy for nonmalignant retroperitoneal fibrosis. Ann Intern Med 2006;144:101-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16418409" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861013006622"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Korte M, Yo M, Betjes M, Fieren MW,\u{A0}van Saase JC,\u{A0}Boer WH,\u{A0}et al. Increasing incidence of severe encapsulating peritoneal sclerosis after kidney transplantation. Nephrol Dial Transplant 2007;22:2412-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17395649" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rigby RJ, Hawley CM. Sclerosing peritonitis: the experience in Australia. Nephrol Dial Transplant 1998;13:154-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9481732" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35422"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/P1-E544-S3766-A11532-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

A successful clinical case of encapsulating peritoneal sclerosis ' surgical management using enterolysis
Éxito en caso clínico de esclerosis peritoneal encapsulante: tratamiento quirúrgico mediante enterólisis
Diálise Peritoneal dos C.H.U.C, Patrícia Netob
b Nefrologia, Centro Hospitalar e Universitário de Coimbra, Portugal,
Read
9764
Times
was read the article
2488
Total PDF
7276
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251412002213"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
  "estado" => "S300"
  "fechaPublicacion" => "2012-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:829-34"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5128
    "formatos" => array:3 [
      "EPUB" => 291
      "HTML" => 4168
      "PDF" => 669
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512002216"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
      "estado" => "S300"
      "fechaPublicacion" => "2012-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:829-34"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6062
        "formatos" => array:3 [
          "EPUB" => 312
          "HTML" => 5075
          "PDF" => 675
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "&#201;xito en caso cl&#237;nico de esclerosis peritoneal encapsulante&#58; tratamiento quir&#250;rgico mediante enter&#243;lisis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => 0
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "829"
            "paginaFinal" => "834"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis &#191; surgical management using enterolysis"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => " Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C, Patr&#237;cia Neto"
            "autores" => array:2 [
              0 => array:1 [
                "apellidos" => "Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C"
              ]
              1 => array:2 [
                "nombre" => "Patr&#237;cia"
                "apellidos" => "Neto"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412002213"
          "doi" => "10.3265/Nefrologia.pre2012.Jul.11532"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002216?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002216/v0_201502091339/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412002190"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Oct.11731"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:835-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4158
      "formatos" => array:3 [
        "EPUB" => 288
        "HTML" => 3332
        "PDF" => 538
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "About the discrepancies between consensus documents&#44; clinical practice guidelines&#44; and legal regulations in the treatment of type 2 diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "835"
          "paginaFinal" => "837"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A prop&#243;sito de las discrepancias entre documentos de consenso&#44; gu&#237;as de pr&#225;ctica cl&#237;nica y normativa legal en el tratamiento de la diabetes tipo 2"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto Mart&#237;nez-Castelao, Jos&#233; L&#46; G&#243;rriz, Eva Sola, Carlos Morillas, Ana Jover, Francisco Coronel, Juan Navarro-Gonz&#225;lez, Fernando de &#193;lvaro"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Mart&#237;nez-Castelao"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233; L&#46;"
              "apellidos" => "G&#243;rriz"
            ]
            2 => array:2 [
              "nombre" => "Eva"
              "apellidos" => "Sola"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Morillas"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Jover"
            ]
            5 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Coronel"
            ]
            6 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Navarro-Gonz&#225;lez"
            ]
            7 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "de &#193;lvaro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002193"
        "doi" => "10.3265/Nefrologia.pre2012.Oct.11731"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002193?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002190?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002190/v0_201502091603/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412002221"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
    "estado" => "S300"
    "fechaPublicacion" => "2012-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:824-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6226
      "formatos" => array:3 [
        "EPUB" => 319
        "HTML" => 5222
        "PDF" => 685
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Cholesterol atheroembolism and combined treatment with steroids and iloprost"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "824"
          "paginaFinal" => "828"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11645_16025_38053_en_f111645_copia.jpg"
              "Alto" => 1035
              "Ancho" => 2114
              "Tamanyo" => 340967
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Evolution of renal function"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Angel Manuel Sevillano Prieto, &#193;ngel M&#46; Sevillano-Prieto, Eduardo Hern&#225;ndez Mart&#237;nez, Eduardo Hern&#225;ndez-Mart&#237;nez, Jara Caro Espada, Jara Caro-Espada, Maria Molina Gomez, Mar&#237;a Molina-G&#243;mez, Eduardo Guti&#233;rrez Mart&#237;nez, Eduardo Guti&#233;rrez-Mart&#237;nez, Enrique Morales Ruiz, Enrique Morales-Ruiz, Ester Gonzalez Monte, Ester Gonz&#225;lez-Monte, Manuel Praga Terente, Manuel Praga-Terente"
          "autores" => array:16 [
            0 => array:2 [
              "nombre" => "Angel Manuel"
              "apellidos" => "Sevillano Prieto"
            ]
            1 => array:2 [
              "nombre" => "&#193;ngel M&#46;"
              "apellidos" => "Sevillano-Prieto"
            ]
            2 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Hern&#225;ndez Mart&#237;nez"
            ]
            3 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Hern&#225;ndez-Mart&#237;nez"
            ]
            4 => array:2 [
              "nombre" => "Jara"
              "apellidos" => "Caro Espada"
            ]
            5 => array:2 [
              "nombre" => "Jara"
              "apellidos" => "Caro-Espada"
            ]
            6 => array:2 [
              "nombre" => "Maria"
              "apellidos" => "Molina Gomez"
            ]
            7 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Molina-G&#243;mez"
            ]
            8 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Guti&#233;rrez Mart&#237;nez"
            ]
            9 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Guti&#233;rrez-Mart&#237;nez"
            ]
            10 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Morales Ruiz"
            ]
            11 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Morales-Ruiz"
            ]
            12 => array:2 [
              "nombre" => "Ester"
              "apellidos" => "Gonzalez Monte"
            ]
            13 => array:2 [
              "nombre" => "Ester"
              "apellidos" => "Gonz&#225;lez-Monte"
            ]
            14 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Praga Terente"
            ]
            15 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Praga-Terente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512002224"
        "doi" => "10.3265/Nefrologia.pre2012.Aug.11645"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002224?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002221?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002221/v0_201502091603/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "A successful clinical case of encapsulating peritoneal sclerosis &#39; surgical management using enterolysis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "829"
        "paginaFinal" => "834"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => " Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C, Patr&#237;cia Neto"
        "autores" => array:2 [
          0 => array:1 [
            "apellidos" => "Di&#225;lise Peritoneal dos C&#46;H&#46;U&#46;C"
          ]
          1 => array:4 [
            "nombre" => "Patr&#237;cia"
            "apellidos" => "Neto"
            "email" => array:1 [
              0 => "patriciaaires3&#64;sapo&#46;pt"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Nefrologia, Centro Hospitalar e Universitário de Coimbra,   Portugal, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#201;xito en caso cl&#237;nico de esclerosis peritoneal encapsulante&#58; tratamiento quir&#250;rgico mediante enter&#243;lisis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
            "Alto" => 771
            "Ancho" => 2172
            "Tamanyo" => 551125
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Potential biomarkers for monitoring membrane injury"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Changes to peritoneal membrane function over time result in the development of ultrafiltration failure in a proportion of peritoneal dialysis &#40;PD&#41; patients and pose a risk for the rarer condition of encapsulating peritoneal sclerosis&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis &#40;EPS&#41; is a rare complication of peritoneal dialysis &#40;PD&#41;&#44; but carries significant morbidity and high mortality of approximately 50&#37;&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Although EPS can be found in different settings&#44; the condition is most frequently seen in patients treated with PD&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">The first cases of EPS in PD patients were reported by Gandhi et al&#46; and Denis et al&#46; in 1980&#46;</p><p class="elsevierStylePara">The multiplicity of suspected etiologies and the its unknown pathogenesis are reflected in the variety of terms that have been used indiscriminately and interchangeably to describe this complication&#44; such as peritoneal fibrosis&#47;peritoneal sclerosis&#47;sclerotic thickening of the peritoneal membrane&#47;sclerotic obstructive peritonitis&#44; calcifying peritonitis&#44; abdominal cocoon and sclerosing peritonitis and sclerosing encapsulating peritonitis&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In 2001 an Ad Hoc committee of the International Society for Peritoneal Dialysis on ultrafiltration management in PD changed the name of the syndrome to encapsulating peritoneal sclerosis &#40;EPS&#41;&#44; which is more descriptive of the morphologic changes&#44; because findings of acute inflammation and peritonitis component is still absent in developed syndrome&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Encapsulating peritoneal sclerosis is characterized by partial or diffuse bowel obstruction&#44; accompanied by marked sclerotic thickening of the peritoneal membrane&#46; The clinical features vary&#44; but they frequently include abdominal pain&#44; nausea&#44; vomiting&#44; weight loss&#44; low-grade fever&#44; hemorrhagic effluent&#44; ultrafiltration failure&#44; ascites and resistance to recombinant human erythropoietin&#46;<span class="elsevierStyleSup">3</span> The development is insidious and probably starts with sterile visceral peritoneal inflammation with neovascularisation&#44; followed by massive deposition of fibrous scar tissue that encases part or the entire bowel&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Longitudinal and cross-sectional studies of peritoneal membrane function with duration of PD have identified that at least two processes seem to be occurring&#46; The rate of small-solutes transport tends to increase with duration on PD reflects early change occurred in peritoneal membrane&#46; The second change with time on treatment occurs in only proportion of patients is a reduction in the capacity of the membrane&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Peritoneal sclerosis is generally recognized as a critical component of EPS&#46; However&#44; the onset of EPS does not result solely from the natural progression of peritoneal sclerosis&#46; A &#8220;second hit&#8221; event&#44; such bacterial peritonitis&#44; abdominal bleeding&#44; or abdominal surgery may be needed to trigger the onset of EPS in the face of advanced peritoneal sclerosis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">With the peritoneal membrane&#44; the epithelial to mesenchymal transition &#40;EMT&#41; is one of the earliest histologic changes in the peritoneum and is a critical step in the development of an abnormal membrane &#40;Scheme 1&#41;&#46; There may be more than on stimulus for EMT&#59; candidates include transforming growth factor &#8211;&#946; &#40;TGF-&#946;&#41;&#44; angiotensin II&#44; fibroblast growth factor&#44; and connective tissue growth factor &#40;CTGF&#41;&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">A number of potential mediators have been postulated in the progressive injury associated with membrane damage &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">The potential to use these mediators as biomarkers is still under investigation&#44; although with-in and between &#8211;patient variability is high and it may help be patterns rather than absolute values that will help the clinician in decision making&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">According with ISPD &#40;International Society for Peritoneal Dialysis&#41; Statement&#44; the tentative diagnosis is made on the basis of a combination of bowel obstruction and features of encapsulation due fibrosis&#46; Laparotomy is the only way to make a definitive diagnosis but usually not done as it can be associated considerable morbidity and mortality&#46;<span class="elsevierStyleSup">5</span> The steps for the diagnosis of EPS are exposed on Table 2&#46;</p><p class="elsevierStylePara">Medical and surgical management of EPS remains unsupported by randomized trials&#46; The role of medical therapies and the timing of surgery are poorly defined&#46;</p><p class="elsevierStylePara">The clinical course of EPS is very variable&#46; Some patients progress rapidly to complete bowel encapsulation and obstruction in few weeks&#44; however others can have a course relatively benign&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DESCRIPTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We report the clinical case of a forty-one years old woman suffering of chronic kidney disease in stage 5 secondary to chronic lithiasic pielonephritis&#46; She started hemodialysis in April 2001&#46; In May of 2002 she received a living donor kidney allograft from her mother and unfortunately she quickly lost it&#44; in consequence of unsolved kinking of the renal artery&#46; In December 2003 she restarted hemodialysis and by personal choice she was evaluated to peritoneal dialysis in consult&#46;</p><p class="elsevierStylePara">In January 2004&#44; she was submitted to implantation of the PD catheter and 4 weeks&#160;after she began this modality&#46; The first peritoneal equilibration test revealed a high average transporter and she started automated PD &#40;Nightly Tidal PD&#41;&#46; During the first 3 years she used hypertonic PD solutions &#40;3&#44;86&#37; glucose&#41; to improve fluid balance and control blood pressure&#44; because icodextrine PD solutions were not available&#46; Despite of this&#44; she was presenting a good peritoneal dialysis adequacy and ultrafiltration membrane capacity&#46;</p><p class="elsevierStylePara">During the first years of PD 2 episodes of infection of the extern orifice exit were registered &#40;unknown germen&#41;&#44; and in the fourth year she had a haemoperitoneum &#40;it was excluded infectious and gynecological causes&#41; accompanied by ultrafiltration failure and her peritoneal membrane transporter status changed to high transporter&#46; In this way&#44; it was introduced 7&#44;5&#37; icodextrine PD solutions&#44; that was associated with increased membrane ultrafiltration &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">In May 2009&#44; she was admitted for a peritonitis diagnosis &#40;abdominal pain and cloudy effluent with a WBC count of 6000&#47;mm<span class="elsevierStyleSup">3</span> and 80&#37; neutrophils&#41;&#46;</p><p class="elsevierStylePara">She began an empiric antibiotic scheme with intermittently intraperitoneal vancomycin &#40;2g every 5 days&#41; and intraperitoneal ceftazidime &#40;1g daily&#41;&#46;</p><p class="elsevierStylePara">On day after&#44; she developed sepsis and were prescribed intravenous antibiotics &#40;meropenem 500mg&#47;day and vancomycin 500mg&#47;three times a week&#41;&#46;</p><p class="elsevierStylePara">The peritoneal fluid culture revealed a methicillin - sensitive&#160;<span class="elsevierStyleItalic">Staphylococcus aureus</span>&#160;that led to addition of rifampin<span class="elsevierStyleItalic">&#160;</span><span class="elsevierStyleItalic">per os</span><span class="elsevierStyleItalic">&#160;</span>&#40;600mg&#47;day&#41;&#46;</p><p class="elsevierStylePara">On the fifth day&#44; the poor clinical evolution led to the diagnosis of refractory peritonitis and peritoneal catheter removal and she was transferred to hemodialysis&#46;<span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara">In spite of this&#44; she maintained abdominal pain and distension&#44; vomiting&#44; diarrhea&#44; severe protein malnutrition and emaciation&#46; The radiological evaluation with computed tomography showed bowel wall thickening and enhancement&#44; focal peritoneal calcification&#44; bowel dilatation and loculated ascites &#40;Figure 2 and Figure 3&#41;&#46;</p><p class="elsevierStylePara">The laboratory findings reflected systemic inflammation &#40;elevated reactive C protein&#41; and electrolytes disturbances &#40;particularly hypokalaemia&#41;&#46;</p><p class="elsevierStylePara">In face of&#44; the encapsulating peritonitis sclerosis diagnostic hypothesis was the more probable&#44; nevertheless the absence of pathological confirmation&#46;</p><p class="elsevierStylePara">In spite of the lack of consensus about pharmacological treatment we prescribed oral prednisone 20mg&#47;day and tamoxifen &#40;10mg&#47;day&#41; with institution of parenteral total nutrition&#46;</p><p class="elsevierStylePara">After more than one month of hospitalization and symptom improvement she was discharged to home and extrahospitalar hemodialysis centre&#46; On discharge date&#44; her nutrition was composed by fluid diet and parenteral nutrition during hemodialysis session&#46;</p><p class="elsevierStylePara">In December 2009&#44; she presented with severe malnutrition &#40;Mass Index Body of 13&#44;6kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; feeding intolerance and uncontrollable vomiting&#46; She had discontinued the tamoxifen by gastrointestinal intolerance&#46;</p><p class="elsevierStylePara">She was readmitted to the Hospital&#44; submitted once again&#44; to an Abdominal Computed Tomography&#44; which showed similar findings to previous ones&#44; with larger areas of loculated ascites &#40;Figure 4 and Figure 5&#41;&#46;</p><p class="elsevierStylePara">Two weeks after admission&#44; she was submitted to surgical management with enterolysis conducted by an experient Surgeon&#46; After this procedure&#44; she began solid diet with progressive tolerance without abdominal pain&#46;</p><p class="elsevierStylePara">She was discharged and her convalescence was short and without intercurrences&#46;</p><p class="elsevierStylePara">In December 2011&#44; she received an allograft from a deceased donor kidney allograft&#44; which took place without major complications&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This is a successful clinical case of EPS&#44; which is a poor prognostic entity&#46;</p><p class="elsevierStylePara">In this case&#44; we found factors that seem implicated in the development of EPS&#59; that were&#58; First&#44; the duration of PD &#40;5 years&#41;&#59; second&#44; the chronic use of &#8220;bioincompatibles&#8221; PD solutions&#46;</p><p class="elsevierStylePara">The treatment of this entity implies supportive therapy to control the ileus &#40;aggressive nutritional support&#41;&#44; medical therapy &#40;anti-fibrotic and anti-inflammatory drugs&#41; and surgical interventional &#40;partial or complete enterolysis without enterectomy&#41;&#46;</p><p class="elsevierStylePara">The support care is the first step because the bowel obstruction causes intense malnutrition that implies early nutritional support with either total parenteral &#40;TPN&#41; or enteral nutrition<span class="elsevierStyleSup">5&#44;6</span> and often time requires long-term nasogastric tube placement&#46; In severely malnourished patients there is a role for TPN for 7 to 10 days before planned surgery&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">There have been no controlled trials of corticosteroid therapy in EPS patients&#46; The timing of steroid use may at least partly explain variations in observed efficacy because corticosteroids would not be expected to treat established fibrosis&#46;</p><p class="elsevierStylePara">Tamoxifen has been used as an antifibrotic in retroperitoneal fibrosis&#46; It is a selective oestrogen receptor modulator &#40;SERM&#41;&#44; predominantly used in the treatment the breast cancer&#46; Another characteristic of tamoxifen is itself activity on the profibrotic cytocine TGF-&#946; and has been show to be effective in fibrotic diseases&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">The efficacy of tamoxifen in EPS has been described only in case series&#46; Korte et al&#46; make the largest study about efficacy of tamoxifen in EPS&#44; from The Netherlands&#44; between 1996 and 2007&#46; Tamoxifen had been given to 24 patients and not used in 39 patients&#46; The duration of tamoxifen use was for 4 weeks or more&#46; Mortality in the tamoxifen group was 45&#44;8&#37; as compared with 74&#44;4&#37; in the untreated group &#40;p 0&#46;03&#41;&#44; and multivariate Cox regression analysis confirmed a trend to better survival in the treated group&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">The surgical management should follow a trial of medical therapy&#46; The time of surgery is thus as important and as yet unresolved factor&#46; Mortality rate after surgery in the published literature has suffered variations&#59; this reflects an increasing surgical expertise&#46; The first experience suggested high mortality when enterectomy and bowel anastomosis was required&#44; but recent reported improved outcome using enterolysis&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Talking about prevention of EPS implies to know that the duration on PD is the only consistent risk factor&#46; There are no prospective data demonstrating any benefit of preemptively switching long-term PD patients to HD&#46; The incidence of EPS increases particularly after 5 or more years of the treatment&#44; however the majority of long-term PD patients will not develop EPS&#46;<span class="elsevierStyleSup">5</span> When considering switching patients from long-term PD to HD preemptively&#44; it may appropriate to select those patients with potentially adverse features such ultrafiltration failure or low ultrafiltration capacity and requirement for high glucose containing concentration dialysate and recurrent episodes of peritonitis&#46; The usually prescription and utilization of &#8220;biocompatible&#8221; PD fluids requires future randomized trials to support these practices&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31058&#95;en&#95;t111532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31058_en_t111532_copia.jpg" alt="Potential biomarkers for monitoring membrane injury"></img></a></p><p class="elsevierStylePara">Table 1&#46; Potential biomarkers for monitoring membrane injury</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31059&#95;en&#95;t211532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31059_en_t211532_copia.jpg" alt="Diagnosis of encapsulating peritoneal sclerosis"></img></a></p><p class="elsevierStylePara">Table 2&#46; Diagnosis of encapsulating peritoneal sclerosis</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31061&#95;en&#95;f211532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31061_en_f211532_copia.jpg" alt="Bowel dilatation&#44; diffuse peritoneal enhancement"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Bowel dilatation&#44; diffuse peritoneal enhancement</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31062&#95;en&#95;f311532&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31062_en_f311532.jpg" alt="Focal peritoneal calcification"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Focal peritoneal calcification</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31063&#95;en&#95;f411532&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31063_en_f411532.jpg" alt="Diffuse peritoneal enhancement"></img></a></p><p class="elsevierStylePara">Figure 4&#46; Diffuse peritoneal enhancement</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31064&#95;en&#95;f511532&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31064_en_f511532_copia.jpg" alt="Loculated ascites"></img></a></p><p class="elsevierStylePara">Figure 5&#46; Loculated ascites</p><p class="elsevierStylePara"><a href="grande&#47;11532&#95;16025&#95;31065&#95;en&#95;f111532&#95;copia&#95;copy1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11532_16025_31065_en_f111532_copia_copy1.jpg" alt="Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity</p>"
    "pdfFichero" => "P1-E544-S3766-A11532-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437197"
          "palabras" => array:1 [
            0 => "Di&#225;lisis peritoneal"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437199"
          "palabras" => array:1 [
            0 => "Esclerosis peritoneal encapsulante"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437201"
          "palabras" => array:1 [
            0 => "Enterolisis"
          ]
        ]
      ]
      "en" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437198"
          "palabras" => array:1 [
            0 => "Peritoneal dialysis"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437200"
          "palabras" => array:1 [
            0 => "Encapsulating peritoneal sclerosis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437202"
          "palabras" => array:1 [
            0 => "Enterolysis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">La esclerosis peritoneal encapsulante &#40;EPE&#41; es una complicaci&#243;n poco com&#250;n&#44; pero grave&#44; de la di&#225;lisis peritoneal&#46; La tasa de incidencia var&#237;a entre el 0&#44;5 y el 4&#44;4 &#37;&#46; Esta complicaci&#243;n est&#225; asociada a tasas significativas de morbilidad y mortalidad&#46; El diagn&#243;stico requiere la presencia de manifestaciones cl&#237;nicas de obstrucci&#243;n intestinal o funci&#243;n gastrointestinal alterada con signos patol&#243;gicos y radiol&#243;gicos de encapsulamiento intestinal&#46; El mecanismo patog&#233;nico exacto de la EPE sigue siendo desconocido&#44; aunque s&#237; que se asocia firmemente con la duraci&#243;n de la di&#225;lisis peritoneal&#46; Presentamos un caso cl&#237;nico de EPE y analizamos las manifestaciones cl&#237;nicas&#44; diagn&#243;stico&#44; tratamiento&#44; pron&#243;stico y prevenci&#243;n&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">The encapsulating peritoneal sclerosis is a rare but serious complication of peritoneal dialysis&#46; The incident rate varies between 0&#46;5 to 4&#46;4&#37;&#46; This entity is associated with significant morbidity and mortality&#46; The diagnosis requires the presence of clinical features of intestinal obstruction or disturbed gastrointestinal function with pathological and radiological evidence of bowel encapsulation&#46; The exact pathogenic mechanism of EPS remains unknown&#44; although it&#8217;s strongest associated with duration of peritoneal dialysis&#46; We present a clinical case of EPS and discuss the clinical manifestations&#44; diagnosis&#44; treatment&#44; prognosis and prevention&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31058_en_t111532_copia.jpg"
            "Alto" => 771
            "Ancho" => 2172
            "Tamanyo" => 551125
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Potential biomarkers for monitoring membrane injury"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31059_en_t211532_copia.jpg"
            "Alto" => 1739
            "Ancho" => 2185
            "Tamanyo" => 901933
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Diagnosis of encapsulating peritoneal sclerosis"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31061_en_f211532_copia.jpg"
            "Alto" => 649
            "Ancho" => 1012
            "Tamanyo" => 233185
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Bowel dilatation&#44; diffuse peritoneal enhancement"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31062_en_f311532.jpg"
            "Alto" => 602
            "Ancho" => 1010
            "Tamanyo" => 223856
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Focal peritoneal calcification"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Fig. 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31063_en_f411532.jpg"
            "Alto" => 668
            "Ancho" => 1010
            "Tamanyo" => 265626
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Diffuse peritoneal enhancement"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Fig. 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31064_en_f511532_copia.jpg"
            "Alto" => 743
            "Ancho" => 1012
            "Tamanyo" => 295540
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Loculated ascites"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11532_16025_31065_en_f111532_copia_copy1.jpg"
            "Alto" => 936
            "Ancho" => 2105
            "Tamanyo" => 334670
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Evolution over time of residual kidney function and ultrafiltration peritoneal membrane capacity"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Davies SJ, Mushahar L, Lambie M. Determinants of peritoneal membrane function over time. Semin Nephrol 2011;31:172-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21439431" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Goodlad C, Brown EA. Encapsulating peritoneal sclerosis: what have we learned? Semin Nephrol 2011;31:183-98. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21439432" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kawaguchi Y, Kawanishi H, Mujais S, Topley N,\u{A0}Oreopoulos DG. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20[suppl 4]:S43-S55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11098928" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861013002806"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Saito A. Peritoneal dialysis in Japan: the issue of encapsulating peritoneal sclerosis and futures challenges. Perit Dial Int 2005;25 Suppl 4:S77-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16300276" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Brown EA, Biesen WV, Finkelstein FO, Hurst H,\u{A0}Johnson DW,\u{A0}Kawanishi H, et al.;\u{A0}ISPD Working Party. Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis: position paper for ISPD. Perit Dial Int 2009;29:595-600. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19910558" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Woodrow G, Augustine T, Brown EA, Cowling M, El-Sherbini N, Hurst H, et al. UK encapsulating peritoneal sclerosis clinical practises guidelines, July 2009. Available at: http://www.renal.org/Libraries/Other_Guidlines/Encapsulating_Peritoneal_Sclerosis_guidelines_UK_EPS_Group_Final_July_2009.sflb.ashx."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 1991;325:525-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1906987" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Van Bommel EF, Hendriksz TR, Huiskes AW, Zeegers AG. Brief communication: tamoxifen therapy for nonmalignant retroperitoneal fibrosis. Ann Intern Med 2006;144:101-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16418409" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861013006622"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Korte M, Yo M, Betjes M, Fieren MW,\u{A0}van Saase JC,\u{A0}Boer WH,\u{A0}et al. Increasing incidence of severe encapsulating peritoneal sclerosis after kidney transplantation. Nephrol Dial Transplant 2007;22:2412-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17395649" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rigby RJ, Hawley CM. Sclerosing peritonitis: the experience in Australia. Nephrol Dial Transplant 1998;13:154-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9481732" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35422"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000006/v0_201502091602/X2013251412002213/v0_201502091603/en/P1-E544-S3766-A11532-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412002213?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 9 6 15
2024 October 63 51 114
2024 September 65 32 97
2024 August 84 75 159
2024 July 49 41 90
2024 June 73 56 129
2024 May 95 40 135
2024 April 70 48 118
2024 March 74 19 93
2024 February 70 33 103
2024 January 62 26 88
2023 December 49 24 73
2023 November 60 32 92
2023 October 74 38 112
2023 September 50 40 90
2023 August 58 17 75
2023 July 80 32 112
2023 June 65 24 89
2023 May 69 32 101
2023 April 57 11 68
2023 March 49 25 74
2023 February 40 22 62
2023 January 53 29 82
2022 December 67 37 104
2022 November 75 42 117
2022 October 69 42 111
2022 September 39 33 72
2022 August 46 52 98
2022 July 43 49 92
2022 June 36 38 74
2022 May 49 28 77
2022 April 46 55 101
2022 March 75 62 137
2022 February 65 44 109
2022 January 71 31 102
2021 December 40 45 85
2021 November 43 36 79
2021 October 61 38 99
2021 September 41 36 77
2021 August 35 40 75
2021 July 43 34 77
2021 June 32 24 56
2021 May 41 41 82
2021 April 67 36 103
2021 March 71 39 110
2021 February 43 19 62
2021 January 50 20 70
2020 December 42 16 58
2020 November 47 17 64
2020 October 38 20 58
2020 September 41 12 53
2020 August 40 13 53
2020 July 44 7 51
2020 June 37 10 47
2020 May 38 13 51
2020 April 40 20 60
2020 March 44 13 57
2020 February 52 16 68
2020 January 55 22 77
2019 December 71 20 91
2019 November 61 16 77
2019 October 37 14 51
2019 September 51 18 69
2019 August 30 18 48
2019 July 48 27 75
2019 June 36 14 50
2019 May 23 20 43
2019 April 37 39 76
2019 March 27 24 51
2019 February 29 20 49
2019 January 43 18 61
2018 December 83 28 111
2018 November 87 11 98
2018 October 88 20 108
2018 September 68 7 75
2018 August 68 18 86
2018 July 57 11 68
2018 June 58 13 71
2018 May 60 14 74
2018 April 62 11 73
2018 March 51 11 62
2018 February 52 11 63
2018 January 50 8 58
2017 December 67 14 81
2017 November 58 5 63
2017 October 49 10 59
2017 September 48 9 57
2017 August 58 11 69
2017 July 50 14 64
2017 June 42 20 62
2017 May 75 19 94
2017 April 61 13 74
2017 March 34 9 43
2017 February 35 20 55
2017 January 25 14 39
2016 December 61 8 69
2016 November 69 9 78
2016 October 125 14 139
2016 September 181 9 190
2016 August 213 8 221
2016 July 172 18 190
2016 June 126 0 126
2016 May 123 0 123
2016 April 96 0 96
2016 March 91 0 91
2016 February 110 0 110
2016 January 105 0 105
2015 December 120 0 120
2015 November 98 0 98
2015 October 116 0 116
2015 September 91 0 91
2015 August 91 0 91
2015 July 100 0 100
2015 June 41 0 41
2015 May 76 0 76
2015 April 8 0 8
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

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

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