Unusual cause of retroperitoneal leak in a patient undergoing peritoneal dialysis

A 63-year-old woman who had been on continuous cycling peritoneal dialysis (PD) for 24 months for end-stage kidney disease due to a homozygous required for meiotic nuclear division 1 homolog (RMND1) mutation was evaluated for a 3-kg weight gain and reduced dialysate effluent in less than a week. RMND1 mutation is a mitochondriopathy also leading to myopathy, leukopenia, ovarian insufficiency, and sensorineural hearing loss. Use of higher concentrations of dextrose solutions was unable to restore dry weight. Physical examination results were unremarkable, except for slight bilateral ankle edema. Notably, there was no evidence of cutaneous fluid accumulation over the abdomen and lumbar region. Biochemistry values were as usual. Peritoneal membrane permeability test did not suggest a membrane failure. Computed tomography scan with intraperitoneal contrast injection showed unusual dialysate leakage in the right anterior and posterior pararenal space (Figure 1a). The patient was temporarily transferred to hemodialysis. After 6 weeks, continuous cycling PD was progressively resumed over a 4-week period to the prior parameters. Computed tomography scan peritoneography performed 1 week and 1 month after PD restart did not reveal any leakage, and PD exchanges have been proceeding normally since then (Figure 1b). Dialysate leaks are common complications of PD but rarely manifest as retroperitoneal leakage in patients undergoing continuous cycling PD. As the patient was practicing physical exercises regularly, we suspect that abrupt increases in intra-abdominal pressure may have contributed to the occurrence of a communication between the parietal peritoneum and pararenal space. No association has yet been described between mitochondriopathy and peritoneal abnormalities. This case highlights the utility of computed tomography scan peritoneography for revealing dialysate leaks and the need to carefully investigate the possibility of retroperitoneal leak in patients undergoing PD. Finally, the occurrence of retroperitoneal leak should not discourage clinicians from resuming PD. All the authors declared no competing interests.