Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high morbidity and mortality but, although various treatment modalities have been tried, the optimal therapy is still debated. The present paper reports a 16-year-old patient who developed EPS 6 months after shifting to haemodialysis and, following adhesiolysis, was successfully treated with a combination of steroids, tamoxifen and everolimus, this last drug chosen for its antiproliferative effect through mammalian target of rapamycin (mTOR) inhibition and its ability to block vascular endothelial growth factor and neoangiogenesis. EPS progressively improved and the patient successfully underwent renal transplantation 5 years later. The case suggests that, in view of their mechanism of action, mTOR inhibitors should be considered as an immunosuppressive agent after renal transplantation in patients at risk and merit investigation in future trials on this condition.
References
Garosi G, Di Paolo N, Sacchi G, Gaggiotti E (2005) Sclerosing peritonitis: a nosological entity. Perit Dial Int 25(supp 3):s110–s112
Korte MR, Sampimon DE, Betjes MGH, Krediet RT (2011) Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol 7(528):538
Io H, Hamada C, Ro Y, Ito Y, Hirahara I, Tomino Y (2004) Morphologic changes of peritoneum and expression of VEGF in encapsulated peritoneal sclerosis rat models. Kidney Intern 65:1927–1936
Balasubramaniam G, Brown EA, Davenport A et al (2009) The Pan-Thames EPS study: treatment and outcome of encapsulating peritoneal sclerosis. Nephrol Dial Transpl 24:3209–3215
Habib SM, Betjes MGH, Fieren MWJA et al (2011) Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment. Neth J Med 69:500–507
Lafrance JP, Létourneau I, Ouimet D et al (2008) Successful treatment of encapsulating peritoneal sclerosis with immunosuppressive therapy. Am J Kidney Dis 51:e7–e10
Izzedine H, Brocheriou I, Frances C (2005) Post-transplantation proteinuria and sirolimus. N Engl J Med 353(19):2088–2089
Khanna A, Cairns V, Hosenpud JD (1999) Tacrolimus induces increased expression of transforming growth factor-β1 in mammalian lymphoid as well as nonlymphoid cells. Transplantation 67:614–619
Rajani R, Smyth J, Koffman CG, Abbs I, Goldsmith DJ (2002) Differential effect of sirolimus vs prednisolone in the treatment of sclerosing encapsulating peritonitis. Nephrol Dial Transplant 17:2278–2280
Duman S, Bozkurt D, Sipahi S et al (2008) Effects of everolimus as an antiproliferative agent on regression of encapsulating peritoneal sclerosis in a rat model. Adv Perit Dial 24:104–110
Huddam B, Azak A, Kocak G, Basaran M, Voyvoda N, Duranay M (2012) Additive effectiveness of everolimus plus tamoxifen therapy in treatment of encapsulating peritoneal sclerosis. Ren Fail 34:387–389
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Frascà, G.M., D’Arezzo, M., Ricciatti, A.M. et al. m-TOR inhibitors may be useful in the treatment of encapsulating peritoneal sclerosis (EPS). J Nephrol 27, 587–590 (2014). https://doi.org/10.1007/s40620-014-0052-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40620-014-0052-5