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Peritoneal morphology in children treated by continuous ambulatory peritoneal dialysis

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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.

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References

  1. Fine RN, Schärer K, Mehls O (1985) CAPD in children. Springer, Berlin Heidelberg New York

    Google Scholar 

  2. Alexander SR (1989) Peritoneal dialysis in children. In: Nolph KD (ed) Peritoneal dialysis, 3rd edn. Kluwer, Dordrecht, pp 343–364

    Google Scholar 

  3. Rizzoni G, Broyer M, Ehrich JHH, Selwood H, Brunner FP, Brynger H, Dykes SR, Fassbinder W, Geerlings W, Tufveson G, Wing A (1990) The use of continuous peritoneal dialysis in Europe for the treatment of children with end-stage renal failure. Data from the EDTA Registry. Nephrol Dial Transplant 5: 985–990

    Google Scholar 

  4. Bonzel KE, Mehls O, Müller-Wiefel DE, Diekmann L, Wartha R, Ruder H, Rascher W, Schärer K (1986) Kontinuierliche ambulante Peritonealdialyse (CAPD) bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 134: 197–204

    Google Scholar 

  5. Bonzel KE, Roth H, Schäter K (1989) Peritoneal access for dialysis in infants and children. In: Andreucci VE (ed) Vascular and peritoneal access for dialysis, Kluwer, Boston, pp 315–331

    Google Scholar 

  6. Gotloib L (1990) The renaissance of the peritoneum as a living membrane. J Nephrol 2: 71–79

    Google Scholar 

  7. Gruskin AB, Lerner GR, Fleischmann LE (1987) Developmental aspects of peritoneal dialysis kinetics. In: Fine RN (ed) Chronic continuous ambulatory and chronic continuous cycling peritoneal dialysis in children. Nijhoff, Boston, pp 33–45

    Google Scholar 

  8. Gotloib L, Shostak A (1989) Peritoneal ultrastructure. In: Nolph KD (ed) Peritoneal dialysis, 3rd edn. Kluwer, Dordrecht, pp 67–98

    Google Scholar 

  9. Dobbie JW (1990) New concepts in molecular biology and ultrastructural pathology of the peritoneum: their significance for peritoneal dialysis. Am J Kidney Dis 15: 97–109

    Google Scholar 

  10. Verger C, Brunschvieg O, Le Charpentier Y, Lavergne A, Vantelon J (1981) Structural and ultrastructural peritoneal membrane changes and permeability alterations during continuous ambulatory peritoneal dialysis. Proc Eur Dial Transplant Assoc 18: 199–203

    Google Scholar 

  11. Verger C, Luger A, Moore H, Nolph KD (1983) Acute changes in peritoneal morphology and trasport properties with infectious peritonitis and mechanical injury. Kidney Int 23: 823–831

    Google Scholar 

  12. Dobbie JW, Zaki MA (1986) The ultrastructure of the parietal peritoneum in normal and uremic man and in patients on CAPD. In: Maher JF, Winchester JF (eds) Frontiers in peritoneal dialysis. Field, New York, pp 3–10

    Google Scholar 

  13. Di Paolo N, Sacchi G, De Mia M, Gaggiotti E, Capotondo C, Bernini M, Pucci AM, Ibba L, Sabatelli P, Alessandrini C (1986) Morphology of the peritoneal membrane during continuous ambulatory dialysis. Nephron 44: 204–211

    Google Scholar 

  14. Dobbie JW (1989) Monitoring peritoneal histopathology in peritoneal dialysis: the role of a biopsy registry. Dial Transplant 18: 319–335

    Google Scholar 

  15. Hirano H, Osawa G (1990) Morphological study of regeneration of the peritoneum (abstract). Abstracts of the 5th International Congress of the International Society for Peritoneal Dialysis July 1990, Kyoto, p 24

  16. Dobbie JW, Lloyd JK, Gall CA (1990) Categorization of ultrastructural changes in peritoneal mesothelium, stroma and blood vessels in uremia and CAPD patients. In: Khauna R, Nolph KD, Prowent B, Twardowski ZF, Oreoponles DG (eds) Adrences in Continuous Ambulatory Peritoneal Dialysis University of Toronto Press: Toronto pp 3–12

    Google Scholar 

  17. Niaudet P, Drachman R, Gubler MC, Broyer M (1985) Loss of ultrafiltration and peritoneal membrane alterations in children on CAPD. In: Fine RN, Schärer K, Mehls O (eds) CAPD in children. Springer, Berlin Heidelberg New York, pp 158–166

    Google Scholar 

  18. Niaudet P (1987) Loss of ultrafiltration and sclerosing encapsulating peritonitis in children undergoing CAPD/CCPD. In: Fine RN (ed) Chronic ambulatory peritoneal dialysis (CAPD) and chronic cycling peritoneal dialysis (CCPD) in children. Nijhoff, Boston, pp 201–219

    Google Scholar 

  19. Schneble F (1990) Morphologie des Peritoneums bei Kindern unter kontinuierlicher ambulanter Peritonealdialyse. Inauguraldissertation, University of Heidelberg

  20. DiPaolo N (1992) Anatomy and physiology of peritoneal membrane. Contr., Nephrol (in press)

  21. Slater ND, Cope GH, Raftery AT (1991) Mesothelial hyperplasia in response to peritoneal dialysis fluid: a morphometric study in the rat. Nephron 58: 466–471

    Google Scholar 

  22. Gallimore B, Gagnon RF, Stevenson MM (1986) Cytotoxicity of commercial peritoneal dialysis solutions towards peritoneal cells of chronically uremic mice. Nephron 43: 283–289

    Google Scholar 

  23. Bronswijk H, Verbrugh HA, Bos HJ, Heezius ECJM, Oe PL, Meulen J van der, Verhoff J (1989) Cytotoxic effects of commercial continuous ambulatory peritoneal dialysis (CAPD) fluids and of bacterial exoproducts on human mesothelial cells in vitro. Perit Dial Int 9: 197–202

    Google Scholar 

  24. Wieslander AP, Nordin MK, Kjellstrand PTT, Boberg UC (1991) Toxicity of peritoneal dialysis fluids on cultured fibroblasts, L-929. Kidney Int 40: 77–79

    Google Scholar 

  25. Watters WB, Buck RC (1972) Scanning electron microscopy of mesothelial regeneration in the rat. Lab Invest 26: 604–609

    Google Scholar 

  26. Pollock CA, Ibels CS, Eckstein RP, Graham JC, Caterson RJ, Mahony AG, Sheil R (1989) Peritoneal morphology on maintenance dialysis. Am J Nephrol 9: 198–204

    Google Scholar 

  27. Ing TS, Daugirdas JT, Ghandi VC (1984) Peritoneal sclerosis in peritoneal dialysis patients. Am J Nephrol 4: 173–176

    Google Scholar 

  28. Heimburger O, Waniewski J, Werynski A, Tranaeno A, Lindholm B (1990) Peritoneal transport in CAPD patients with permanent loss of ultrafiltration capacity. Kidney Int 38: 495–506

    Google Scholar 

  29. Oulès R, Challah S, Brunner FP (1988) Case-control study to determine the cause of sclerosing peritoneal disease. Nephrol Dial Transplant 3: 66–69

    Google Scholar 

  30. Di Paolo N, Sacchi G (1989) Peritoneal vascular changes in continuous ambulatory peritoneal dialysis (CAPD): an in vivo model for the study of diabetic microangiopath. Perit Dial Int 9: 41–45

    Google Scholar 

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Schneble, F., Bonzel, KE., Waldherr, R. et al. Peritoneal morphology in children treated by continuous ambulatory peritoneal dialysis. Pediatr Nephrol 6, 542–546 (1992). https://doi.org/10.1007/BF00866498

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  • DOI: https://doi.org/10.1007/BF00866498

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