Peritoneal morphology in children treated by continuous ambulatory peritoneal dialysis

Abstract

Fifty peritoneal biopsies (PB) from 35 patients with end-stage renal disease, treated by continuous ambulatory peritoneal dialysis (CAPD) and aged 2 months to 18 years, were examined by light microscopy (n = 50) and/or scanning electron microscopy. PB were performed during surgical procedures immediately before the start of, during, or after the cessation of CAPD treatment. PB from 15 children without renal disease undergoing laparatomy were examined similarly. Before the start of CAPD, a scarcity and shortening of the mesothelial microvilli was observed by scanning electron microscopy. During and after CAPD, variable alterations of mesothelium, interstitium and capillaries were found. The mesothelial layer was absent in all 5 PB obtained during episodes of active peritonitis. In patients treated by CAPD for longer than 6 months, mesothelial denudation was observed more frequently (6/11) than in children treated for shorter periods (1/7) (P < 0.08). Fibrosis of the peritoneal membrane was present in about 50% of patients during or after the cessation of CAPD without impairment of peritoneal function. No correlation was found between the presence of fibrosis and the frequency of peritonitis or the duration of CAPD treatment.

Single-center experience of encapsulating peritoneal sclerosis in patients on peritoneal dialysis for end-stage renal failure

“…It is proposed that given the association shown by our study between severity and total duration of PD and the previous successful case reports of treatment by peritoneal rest [7,8,13,[23][24][25][26][27][28] that wherever possible, patients should be switched to hemodialysis or transplanted at diagnosis. However, even removing the putative driving force for the disease process by withdrawing PD is not always successful [29].…”

Morphological Changes in the Peritoneal Vasculature of Patients on CAPD with Ultrafiltration Failure

“…Mésothélial, interstitial and vascular alterations were described during C A P D thera py. Schneble et al [17] reported that loss o f the mésothé lial layer appeared to be related to prolonged duration o f C A P D treatment, and was independent o f the occurrence o f peritonitis. Since the peritoneum is very vulnerable, however, it is often difficult to distinguish intrinsic lesions from artifacts due to tissue injury during sampling.…”

Pathophysiological Changes to the Peritoneal Membrane during PD-Related Peritonitis: The Role of Mesothelial Cells

“…Vascular and interstitial changes become more apparent with progressive use of PD, thereby demonstrating a temporal relationship between peritoneal fibrosis, vasculopathy, and time on PD [3]. Peritoneal fibrosis is detected in 50% and 80% of PD patients within one and two years, respectively, on PD [78–80]. With regards to mesothelial cells, independent researchers have demonstrated significant changes to these cells following their exposure to PD, which include cell activation, cell hypertrophy, increased vacuolation, partial or complete loss of microvilli, dissolution of cell-cell contacts, and alterations in the number of endoplasmic reticulum and micropinocytotic vesicles [3, 74, 75, 81].…”