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EPS Diagnosis PD Long-Term — ESENeph MCQ

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HardPeritoneal DialysisEPS Diagnosis PD Long-TermESENeph

A 45-year-old man on peritoneal dialysis has gradually worsening UF failure over 18 months. His D/P creatinine on PET has changed from 0.65 to 0.82. He has had multiple peritonitis episodes. He develops abdominal pain, anorexia, and bloody dialysate. CT shows peritoneal calcification and small bowel cocoon. What is this condition?

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Correct answer: E — Encapsulating peritoneal sclerosis

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term PD characterised by progressive peritoneal thickening, fibrosis, and calcification that encases the bowel ('cocoon'). Risk factors include PD duration >5 years, recurrent peritonitis episodes, and progressive UF failure with rising D/P Cr (indicating increased peritoneal permeability from membrane damage). Symptoms include bowel obstruction, bloody dialysate, weight loss, and inflammation. The transition from type II (simple UF failure) to type III (inflammatory/EPS) is signalled by bloody effluent and rising inflammatory markers. Management includes PD cessation, nutritional support (often TPN), tamoxifen, and surgical enterolysis for obstruction in selected cases.

Reference: Johnson et al 2010 – EPS Diagnostic Criteria; ISPD 2009 – EPS Consensus Guidelines