The Authors Reply:

Abstract

We read with interest the report ‘Milky ascites is not always chylous’,1.Olde Loohuis K.M. Jahnen-Dechent W. van D.W. The case mid R: milky ascites is not always chylous.Kidney Int. 2010; 77: 77-78Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar in which the authors attribute milky ascites in a patient with calcified sclerosing peritonitis to massive intraperitoneal amounts of calcium-hydroxyphosphate–apatite crystals and colloidal calcium-phosphate–fetuin-A complexes (calciprotein particles). We have some questions, as this is at most a seldom presentation of encapsulating peritoneal sclerosis (EPS).2.Brown M.C. Simpson K. Kerssens J.J. et al.Encapsulating peritoneal sclerosis in the new millennium: a national cohort study.Clin J Am Soc Nephrol. 2009; 4: 1222-1229Crossref PubMed Scopus (150) Google Scholar,3.Chin A.I. Yeun J.Y. Encapsulating peritoneal sclerosis: an unpredictable and devastating complication of peritoneal dialysis.Am J Kidney Dis. 2006; 47: 697-712Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar First, the authors mention that the patient's peritoneal permeability was suggestive of sclerosing peritonitis. Although this does not seem unlikely given both a long-term exposure to peritoneal dialysis (PD) and the peritoneal calcifications, a diagnosis of EPS relies on clinical and radiological grounds: bouts of recurrent, intermittent, or persisting episodes of intestinal obstructions2.Brown M.C. Simpson K. Kerssens J.J. et al.Encapsulating peritoneal sclerosis in the new millennium: a national cohort study.Clin J Am Soc Nephrol. 2009; 4: 1222-1229Crossref PubMed Scopus (150) Google Scholar,3.Chin A.I. Yeun J.Y. Encapsulating peritoneal sclerosis: an unpredictable and devastating complication of peritoneal dialysis.Am J Kidney Dis. 2006; 47: 697-712Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar with, on computed tomography scan, the presence of peritoneal thickening and calcifications, bowel wall thickening, tethering and bowel dilations, and intra-abdominal fluid loculations.4.Tarzi R.M. Lim A. Moser S. et al.Assessing the validity of an abdominal CT scoring system in the diagnosis of encapsulating peritoneal sclerosis.Clin J Am Soc Nephrol. 2008; 3: 1702-1710Crossref PubMed Scopus (95) Google Scholar Did this patient have clinical or radiological evidence of EPS? Second, more data on ascites volume, density, and concentration of other constituents (creatinine, protein, etc.) could determine whether the patient is having compartmentalized ascites (‘loculation’), with no exchanges across the peritoneal membrane, or ‘dynamic’ recently generated ascites. The former, but not the latter, might explain the markedly elevated concentrations of calciprotein particles. Finally, it would have been of interest to test in vitro, in a test tube, the apparition of a similar ‘milky’ coloration by mixing huge amounts of calciprotein particles with a PD used effluent. Given the increasing incidence of EPS,2.Brown M.C. Simpson K. Kerssens J.J. et al.Encapsulating peritoneal sclerosis in the new millennium: a national cohort study.Clin J Am Soc Nephrol. 2009; 4: 1222-1229Crossref PubMed Scopus (150) Google Scholar,3.Chin A.I. Yeun J.Y. Encapsulating peritoneal sclerosis: an unpredictable and devastating complication of peritoneal dialysis.Am J Kidney Dis. 2006; 47: 697-712Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar more data from the present case might help clinicians to recognize this complication.