Korean J Nephrol.  2004 Sep;23(5):830-835.

Two Cases of Successful Use of Urokinase in Continuous Ambulatory Peritoneal Dialysis Patients with Relapsing Peritonitis

• Baek JY
• Shin SJ
• Joo KR
• Shim BJ
• Park YK
• Park JC
• Song HC
• Choi EJ

Abstract

Peritonitis is a frequent and serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Recently, due to educational promotion in general hygiene and development of laboratory technique for bacterial cultures and sensitivity test, proper use of antibiotics, the incidence of CAPD peritonitis has gradually decreased. However, CAPD peritonitis is still one of the most common causes of peritoneal dialysis failure and of removal peritoneal catheter. It has been suggested that the formation of biofilm on the inner surface of peritoneal catheter leads to relapsing peritonitis and removal of the peritoneal catheter in CAPD patients. The biofilm is a kind of protecting coat which consists of fibrin inhibiting the penetration of antibiotics. It surrounds and covers the bacteria, making them to survive from the attack of antibiotics. Therefore thrombolytic therapy, urokinase modifies the structure of biofilm, and helps the antibiotics penetrating the fibrin coat, eventually amplify the bacteriocidal effect. We experienced two cases of successful treatment with urokinase and antibiotics in CAPD peritonitis patients. The combination of thrombolytic agents and antibiotics might be one of the strategies for the treatment of CAPD patients who experienced it frequently.

Keyword

CAPD; Peritonitis; Urokinase

MeSH Terms

Anti-Bacterial Agents
Bacteria
Biofilms
Catheters
Fibrin
Fibrinolytic Agents
Humans
Hygiene
Incidence
Peritoneal Dialysis
Peritoneal Dialysis, Continuous Ambulatory*
Peritonitis*
Thrombolytic Therapy
Urokinase-Type Plasminogen Activator*
Anti-Bacterial Agents
Fibrin
Fibrinolytic Agents
Urokinase-Type Plasminogen Activator