Abstract
A 76-year-old man developed fever and appetite loss, and then was referred to our hospital because of rapidly progressive renal insufficiency; his serum creatinine increased from 1.2 to 5.9 mg/dl within 1 month. On admission, his blood pressure was 166/92 mmHg, and laboratory findings showed signs of inflammation, anemia, proteinuria, and hematuria. Chest computed tomography (CT) suggested interstitial pneumonia, while a renal biopsy revealed that small arteries and arterioles were affected, and there was pauci-immune glomerulonephritis with cellular and fibrocellular crescents. In addition, an increased myeloperoxidase antineutrophil cytoplasmic antibody titer confirmed microscopic polyangiitis. Treatment with oral prednisolone was initiated and seemed to successfully resolve the vasculitis activity. On the 11th day of admission, a calcium channel blocker, azelnidipine, was added to treat hypertension. Two days later, the patient developed abdominal distension, and abdominal CT showed massive ascites. The ascitic fluid was a milky white transudate with a normal leukocyte count. Neither clinical manifestations nor laboratory findings suggestive of liver cirrhosis, malignancy, infectious peritonitis, or bowel perforation were observed. On the 18th day of admission, azelnidipine was discontinued in view of reports of calcium channel blocker-induced chyloperitoneum in patients undergoing peritoneal dialysis. Immediately, the abdominal distension disappeared, and the ascites appeared to decrease. Azelnidipine appears to have been responsible for the chyloperitoneum. Since a few cases of secondary vasculitis developing chyloperitoneum have been previously reported, vasculitis may have played a role in the development of chyloperitoneum.
Similar content being viewed by others
References
Yoshimoto K, Saima S, Nakamura Y. Manidipine hydrochloride induced peritoneal fluid turbidity in two patients on continuous peritoneal dialysis. J Jpn Soc Dial Ther. 1991;24:1171–3.
Tanabe M, Iwata H, Kinoshita M, Sumiya M, Saima S. Manidipine hydrochloride-induced chyloperitoneum in a patient with systemic lupus erythematosus. Clin Nephrol. 1999;51:195–6.
Lee T-H, Lee EY, Cho YS, Yoo B, Moon H-B, Lee C-K. Concurrent occurrence of chylothorax and chylous ascites in a patient with Henoch-Schönlein purpura. Scand J Rheumatol. 2003;32:378–9.
Abadoğlu O, Osma E, Uçan ES, Cavdar C, Akkoç N, Küpelïoğlu A, Akbaylar H. Behçet’s disease with pulmonary involvement, superior vena cava syndrome, chyloptysis and chylous ascites. Respir Med. 1996;90:429–31.
Sakai H, Kurokawa K, Koyama A, Arimura Y, Kida H, Shigematsu S, et al. Clinical guideline for rapidly progressive glomerulonephritis in Japan. Jpn J Nephrol. 2002;44:55–82.
Koyama A, Yamagata K, Makino H, Arimura Y, Wada T, Nitta K, et al. A nationwide survey of rapidly progressive glomerulonephritis in Japan: etiology, prognosis and treatment diversity. Clin Exp Nephrol. 2009;13:633–50.
Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330:337–42.
Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117:215–20.
Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med. 1982;96:358–64.
Cárdenas A, Chopra S. Chylous ascites. Am J Gastroenterol. 2002;97:1896–900.
Browse NL, Wilson NM, Russo F, al-Hassan H, Allen DR. Aetiology and treatment of chylous ascites. Br J Surg. 1992;79:1145–50.
Pomeranz A, Reichenberg Y, Schurr D, Drukker A. Chyloperitoneum: a rare complication of peritoneal dialysis. Perit Dial Int. 1984;4:35–7.
Yoshimoto K, Saima S, Nakamura Y, Nakayama M, Kubo H, Kawaguchi Y, et al. Dihydropyridine type calcium channel blocker-induced turbid dialysate in patients undergoing peritoneal dialysis. Clin Nephrol. 1998;50:90–3.
Tanaka M, Ito K, Matsushita K, Matsushita K. Calcium channel blocker: azelnidipine induced turbid dialysate in patients undergoing peritoneal dialysis. J Jpn Soc Dial Ther. 2006;39(Suppl 1):1000.
Kato A, Hishida A, Nakajima T, Ohtake T, Furuya R, Arai T, et al. Manidipine hydrochloride-induced chyloperitoneum in a patient on continuous ambulatory peritoneal dialysis. J Jpn Soc Dial Ther. 1994;27:1185–8.
Trost BN, Weidmann P. Effects of calcium antagonists on glucose homeostasis and serum lipids in non-diabetic and diabetic subjects: a review. J Hypertens. 1987;5:81–104.
Bailey M, Chapin W, Licht H, Reynolds JC. The effects of vasculitis on the gastrointestinal tract and liver. Gastroenterol Clin N Am. 1998;27:747–82.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yamamoto, T., Matsuda, J., Kadoya, H. et al. Azelnidipine-induced chyloperitoneum in a patient with microscopic polyangiitis. Clin Exp Nephrol 14, 496–500 (2010). https://doi.org/10.1007/s10157-010-0302-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-010-0302-3