Peritoneal dialysis (PD) is widely used in chronic and acute disorders
, Acute hydrothorax (AH) is a complication of PD that contraindicates
further use of the method. Two cases are reported herein. One patient
was a 13-year-old girl with endstage renal failure due to steroid-resi
stant nephrotic syndrome, Three days after initiation of PD (4 x 1250
ml/day), she developed cough and dyspnea due to right-sided hydrothora
x. Chemical analysis showed that the fluid in the pleural cavity was p
eritoneal fluid, The hydrothorax persisted despite dialysate volume re
duction, Because construction of an arteriovenous fistula was not feas
ible (because of thrombotic complications), talc poudrage of the pleur
al cavity was performed. Pleuroscopy failed to locate the communicatio
n through the diaphragm, PD was resumed after ten days with no further
complications, The other patient was a six-year-old boy with acute re
nal failure due to hemolytic uremic syndrome. Forty-eight hours after
the beginning of PD (12 cycles/24 hours, 30 ml/kg), a positive fluid b
alance and impaired breathing suggested right-sided hydrothorax. This
diagnosis was confirmed by findings from a physical evaluation and pla
in chest film. PD was stopped and intermittent hemodialysis via a Quin
ton intracaval catheter was initiated. The outcome was favorable. Hydr
othorax is an infrequent complication of PD that should be looked for
when respiratory symptoms develop after PD initiation or when the flui
d balance is positive. Continuation of PD can lead to respiratory dist
ress. In most cases, the hydrothorax persists despite a decrease in di
alysis volume or temporary discontinuation of PD, requiring use of ano
ther dialysis method. Pleural poudrage can be performed in the few cas
es where no alternative to PD is available.