scholarly journals Recommendations for pathological diagnosis on biopsy samples from peritoneal dialysis patients

2017 ◽  
Vol 2 (1) ◽  
pp. 3-15 ◽  
Author(s):  
Kunio Kawanishi ◽  
Kazuho Honda ◽  
Chieko Hamada
Keyword(s):  
Peritoneal Dialysis ◽  
Inflammatory Cells ◽  
Vascular Wall ◽  
Measuring System ◽  
Histological Evaluation ◽  
Membranous Structure ◽  
Visceral Peritoneum ◽  
Compact Zone ◽  
Stage Renal Disease ◽  
Almost All

AbstractPeritoneal dialysis (PD) has been established as an essential renal replacement therapy for patients with end stage renal disease during the past half century. Histological evaluation of the peritoneal membrane has contributed to the pathophysiological understanding of PD-related peritoneal injury such as peritonitis, fibrosis, and encapsulating peritoneal sclerosis (EPS). Hyalinizing peritoneal sclerosis (HPS), also known as simple sclerosis, is observed in almost all of PD patients. HPS is morphologically characterized by fibrosis of the submesothelial interstitium and hyalinizing vascular wall, particularly of the post-capillary venule (PCV). Two histological factors, the thickness of submesothelial compact zone (SMC) and the lumen/vessel ratio (L/V) at the PCV, have been used for the quantitative evaluation of HPS. The measuring system on SMC thickness and L/V ratio is easy and useful for evaluating the severity of HPS. On the other hand, EPS is characterized by unique encapsulation of the intestines by an “encapsulating membrane”. This newly formed membranous structure covers the visceral peritoneum of the intestines, which contains fibrin deposition, angiogenesis, and proliferation of fibroblast-like cells and other inflammatory cells. This review will cover the common understandings of PD-related peritoneal alterations and provide a basic platform for clinical applications and future studies in this field.

scholarly journals Anti-C5a complementary peptide mitigates zymosan-induced severe peritonitis with fibrotic encapsulation in rats pretreated with methylglyoxal

2018 ◽  
Vol 315 (6) ◽  
pp. F1732-F1746 ◽  
Author(s):  
Daiki Iguchi ◽  
Masashi Mizuno ◽  
Yasuhiro Suzuki ◽  
Fumiko Sakata ◽  
Shoichi Maruyama ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Subsequent Development ◽  
Inflammatory Cells ◽  
Therapeutic Effects ◽  
Pathological Changes ◽  
Dialysis Patients ◽  
Visceral Peritoneum ◽  
Peritoneal Encapsulation ◽  
Severe Peritonitis

In a previous study of fungal peritoneal injury in peritoneal dialysis patients, complement (C)-dependent pathological changes were developed in zymosan (Zy)-induced peritonitis by peritoneal scraping. However, the injuries were limited to the parietal peritoneum and did not show any fibrous encapsulation of the visceral peritoneum, which differs from human encapsular peritoneal sclerosis (EPS). We investigated peritoneal injury in a rat model of Zy-induced peritonitis pretreated with methylglyoxal (MGO) instead of scraping (Zy/MGO peritonitis) to clarify the role of C in the process of fibrous encapsulation of the visceral peritoneum. Therapeutic effects of an anti-C5a complementary peptide, AcPepA, on peritonitis were also studied. In Zy/MGO peritonitis, peritoneal thickness, fibrin exudation, accumulation of inflammatory cells, and deposition of C3b and C5b-9 with loss of membrane C regulators were increased along the peritoneum until day 5. On day 14, fibrous encapsulation of the visceral peritoneum was observed, resembling human EPS. Peritoneal injuries and fibrous changes were significantly improved with AcPepA treatment, even when AcPepA was administered following injection of Zy in Zy/MGO peritonitis. The data show that C5a might play a role in the development of encapsulation-like changes in the visceral peritoneum in Zy/MGO peritonitis. AcPepA might have therapeutic effects in fungal infection-induced peritoneal injury by preventing subsequent development of peritoneal encapsulation.

Variability in Case Mix and Peritoneal Dialysis Selection in Fifty-Nine French Districts

2008 ◽  
Vol 28 (5) ◽  
pp. 509-517 ◽  
Author(s):  
Cécile Couchoud ◽  
Emilie Savoye ◽  
Luc Frimat ◽  
Jean-Philippe Ryckelynck ◽  
Ylana Chalem ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Behavioral Disorders ◽  
Hierarchical Classification ◽  
Ratio Test ◽  
First Choice ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

In France, the use of peritoneal dialysis (PD) as the first-choice treatment varies greatly between districts, as it is already known to do between countries. Baseline clinical factors associated with choice of first modality were analyzed in 10815 new end-stage renal disease patients in 59 districts. To describe practices at the district level, we used an agglomerative hierarchical classification, with proximity defined by a likelihood-ratio test that compared multivariate logistic regressions of the following factors: age, gender, diabetes, congestive heart failure, severe behavioral disorders, mobility, and employment. To propose a typology, each cluster of districts was described by a multivariate logistic regression. While populations starting PD in France, as elsewhere, are more likely to be young or employed, they are also more likely to be elderly or have congestive heart failure or severe behavioral disorders. Overall, 14% of patients start with PD, but this rate varies significantly across districts, from 0% to 45%. A specific combination of factors was associated with the first-choice modality in each group of districts. This study highlights the lack of consensual medical criteria for this choice and the likelihood that nonmedical factors may explain the observed differences. The high variability suggests that PD can be used in almost all clinical conditions. Accordingly, patient preference should play a more important role in the decision-making process.

scholarly journals Extracellular Vesicles and Their Relationship with the Heart–Kidney Axis, Uremia and Peritoneal Dialysis

Toxins ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 778
Author(s):  
Carolina Amaral Bueno Azevedo ◽  
Regiane Stafim da Cunha ◽  
Carolina Victoria Cruz Junho ◽  
Jessica Verônica da Silva ◽  
Andréa N. Moreno-Amaral ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Extracellular Vesicles ◽  
Cardiorenal Syndrome ◽  
Cell Types ◽  
Renal Tissue ◽  
Uremic Toxin ◽  
Home Based ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

Cardiorenal syndrome (CRS) is described as primary dysfunction in the heart culminating in renal injury or vice versa. CRS can be classified into five groups, and uremic toxin (UT) accumulation is observed in all types of CRS. Protein-bound uremic toxin (PBUT) accumulation is responsible for permanent damage to the renal tissue, and mainly occurs in CRS types 3 and 4, thus compromising renal function directly leading to a reduction in the glomerular filtration rate (GFR) and/or subsequent proteinuria. With this decrease in GFR, patients may need renal replacement therapy (RRT), such as peritoneal dialysis (PD). PD is a high-quality and home-based dialysis therapy for patients with end-stage renal disease (ESRD) and is based on the semi-permeable characteristics of the peritoneum. These patients are exposed to factors which may cause several modifications on the peritoneal membrane. The presence of UT may harm the peritoneum membrane, which in turn can lead to the formation of extracellular vesicles (EVs). EVs are released by almost all cell types and contain lipids, nucleic acids, metabolites, membrane proteins, and cytosolic components from their cell origin. Our research group previously demonstrated that the EVs can be related to endothelial dysfunction and are formed when UTs are in contact with the endothelial monolayer. In this scenario, this review explores the mechanisms of EV formation in CRS, uremia, the peritoneum, and as potential biomarkers in peritoneal dialysis.

Intraperitoneal Administration of Recombinant Human Erythropoietin in Uremic Animals

1988 ◽  
Vol 8 (4) ◽  
pp. 249-252 ◽  
Author(s):  
Joanne M. Bargman ◽  
Andre Breborowicz ◽  
Helen Rodela ◽  
Kostas Sombolos ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Recombinant Human Erythropoietin ◽  
Dialysis Patient ◽  
Intraperitoneal Administration ◽  
Peritoneal Dialysis Patient ◽  
Human Erythropoietin ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

Previous protocols of administration of recombinant human erythropoietin to patients with end-stage renal disease have been by the i.v. route. Because this method would be impractical for the continuous ambulatory peritoneal dialysis patient, we designed an i.p. dosing protocol in uremic rabbits to examine whether significant amounts of this hormone could be absorbed from the peritoneal cavity. Our results demonstrate that almost all of the erythropoietin is absorbed (or adsorbed) during a prolonged dwell when administered undiluted by dialysate.

Various Obstacles to Peritoneal Dialysis Development in Japan: Too Much Money? Too Much Fear?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 56-58
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Penetration Rate ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

At 31 December 2005, the number of patients on maintenance dialysis in Japan was 257,765, with 9599 patients having started dialysis that year. Kidney transplant cases in Japan number about 1000 annually. Thus, almost all end-stage renal disease patients in Japan are likely to live on dialysis for the remainder of their lives. For various reasons, peritoneal dialysis has a lower penetration rate among Japanese dialysis patients, and work to educate patients and nephrologists about PD needs to be done.

scholarly journals Activated Protein C Prevents Peritoneal Fibrosis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4229-4229
Author(s):  
Peyman Dinarvand ◽  
Seyed Mahdi Hassanian Mehr ◽  
Alireza R. Rezaie
Keyword(s):  
Peritoneal Dialysis ◽  
Mrna Expression ◽  
Conflicts Of Interest ◽  
Therapeutic Potential ◽  
Intraperitoneal Administration ◽  
Activated Protein C ◽  
Histological Evaluation ◽  
Peritoneal Fibrosis ◽  
Permeable Membrane ◽  
Stage Renal Disease

Abstract Patients with chronic kidney disease require dialysis (hemodialysis or peritoneal dialysis) for treatment. Peritoneal dialysis is an alternative to hemodialysis for the treatment of end-stage renal disease and is based on the use of the peritoneum as a permeable membrane where ultrafiltration and diffusion between dialysate and blood can take place across the peritoneum. Peritoneal fibrosis is one of the main complications of peritoneal dialysis and affects up to 20% of patients undergoing continuous ambulatory peritoneal fibrosis. The exact mechanism of this process has yet to be elucidated and no effective therapy for the problem has been established. APC is a natural vitamin-K dependent anticoagulant protease, which also has potent antiinflammatory activity. We hypothesized that the antiinflammatory function of APC may inhibit dialysis-mediated peritoneal fibrosis. To test this hypothesis, we generated a chlorhexidine gluconate (CG)-induced peritoneal fibrosis model by injecting CG to male C57BL/6 mice for 21 days with or without intraperitoneal administration of a low dose of recombinant APC (50 µg/kg/day bodyweight) one hour before injecting CG. At 10 and 21 days after injection, the mice were sacrificed and the parietal peritoneum and omentom were dissected for histological evaluation and for analysis of expression of inflammatory molecules. Strikingly, we discovered that APC inhibits the thickness of peritoneal fibrosis and potently inhibits the mRNA expression of TGF-b1, cytokeratins, a2-integrin, MMP-2 and 9 and also significantly increases the mRNA expression of TIMP-2 in peritoneal tissues of the experimental animals. We also discovered that APC significantly decreases the concentration of TGF-b1 and dramatically increases the concentration of tPA in peritoneal fluids. Taken together, our findings suggest that APC may have therapeutic potential in ameliorating dialysis-mediated peritoneal fibrosis. Disclosures No relevant conflicts of interest to declare.

scholarly journals Dialysis Provision and Implications of Health Economics on Peritoneal Dialysis Utilization: A Review from a Malaysian Perspective

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Mohd Rizal Abdul Manaf ◽  
Naren Kumar Surendra ◽  
Abdul Halim Abdul Gafor ◽  
Lai Seong Hooi ◽  
Sunita Bavanandan
Keyword(s):  
Peritoneal Dialysis ◽  
Economic Benefits ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Geographical Regions ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage ◽  
Private Financing ◽  
Esrd Patients

End-stage renal disease (ESRD) is managed by either lifesaving hemodialysis (HD) and peritoneal dialysis (PD) or a kidney transplant. In Malaysia, the prevalence of dialysis-treated ESRD patients has shown an exponential growth from 504 per million population (pmp) in 2005 to 1155 pmp in 2014. There were 1046 pmp patients on HD and 109 pmp patients on PD in 2014. Kidney transplants are limited due to lack of donors. Malaysia adopts public-private financing model for dialysis. Majority of HD patients were treated in the private sector but almost all PD patients were treated in government facilities. Inequality in access to dialysis is visible within geographical regions where majority of HD centres are scattered around developed areas. The expenditure on dialysis has been escalating in recent years but economic evaluations of dialysis modalities are scarce. Evidence shows that health policies and reimbursement strategies influence dialysis provision. Increased uptake of PD can produce significant economic benefits and improve patients’ access to dialysis. As a result, some countries implemented a PD-First or Favored Policy to expand PD use. Thus, a current comparative costs analysis of dialysis is strongly recommended to assist decision-makers to establish a more equitable and economically sustainable dialysis provision in the future.

Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Glen H Stanbaugh ◽  
A. W, Holmes Diane Gillit ◽  
George W. Reichel ◽  
Mark Stranz
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Overload ◽  
End Stage Renal Disease ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Peritoneal Dialysate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

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