Case Study

Chronic Renal Failure: Rule Out Peritonitis, Peritoneal Dialysis 

Michael R. Broyles, PharmD – Director of Pharmacy and Lab Services 

Age, sex:

79-year-old male

Chief complaint:

Abdominal pain and soreness, febrile

Significant medical history:

Chronic renal failure, peritoneal dialysis for five years, autoimmune disease, hypertension (HTN), diabetes mellitus (DM)

 

Admission labs:

PCT = 1.26 μg/L, serum creatinine = 6.8 mg/dL, blood urea nitrogen (BUN) = 30 mg/dL, white blood count (WBC) = 12.6 x 103/µL, neutrophils 85.7 109/L, lactate 2.3 mmol/L, peritoneal dialysis effluent = clear

Admitting diagnosis:

Peritonitis which was subsequently confirmed

Treatment, interventions:

Antibiotics started into peritoneal cavity, vancomycin and tobramycin with doses adjusted for trough values

Follow-up labs:

  • Baseline: PCT = 1.26 μg/L
  • Day 1: PCT = 0.72 μg/L
  • Day 2: PCT = 0.45 μg/L
  • Day 3: PCT = 0.45 μg/L


Resolution:

PCT successfully trended down by approximately 50% daily.

Key takeaways

 

“The normal baseline PCT in renal patients is typically a bit higher—we use 0.5 μg/L at my facility.”1 PCT is useful in patients on peritoneal dialysis, and trending is quite useful. Note that there was a steady decrease in PCT, by approximately 50% per day.

 

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References
  1. Meisner M. Procalcitonin-biochemistry and clinical diagnosis. Dresden (Germany): UNI-MED-Verlag; 2010.