[Morpho-functional study of peritoneum in peritoneal dialysis].
BACKGROUND
Peritoneal dialysis (PD) impairs both structure and function of the peritoneal membrane (PM). Aim of the study is to examine the relationship among dialytic, histological and functional parameters in PD patients.


METHODS
Thirty-one PD patients were submitted to peritoneal biopsy (PB) during catheter removal for malfunction or after dropping out of the treatment. For each patient PM transport was evaluated by the last peritoneal equilibration test (PET) prior to PB. Each daily glucose load was calculated. PB was performed at a distance of at least 5 cm from the catheter insertion point. The tissues were promptly embedded in formalin and stained for histological and immunohistochemical studies.


RESULTS
1) Patients with mesothelial impairment had longer treatment time. 2) Patients presenting submesothelial sclerosis (SS) and those with impairment of submesothelial basement membrane and subendothelial vascular membrane (SVM) were submitted to larger daily glucose loads. 3) High transporters were exposed to larger daily glucose loads and presented an SS thickness greater than 50 micron more frequently than medium-high transporters. 4) Mesothelial loss was correlated with SS and vascular alterations. 5) SS and vascular injuries were related to each other and not to inflammatory infiltrate.


CONCLUSIONS
Our study suggests that PD length seems to be mainly involved in mesothelial impairment; glucose load appears to damage mainly the submesothelial layer; SS is not a constant event in PD patients and in itself does not seem to be a decisive factor in PD drop out.
U.O. di Nefrologia e Dialisi, Policlinico MultiMedica, Sesto San Giovanni (MI), Italy. silvio.bertoli@multimedica.it
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Bertoli
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Buzzi
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Ciurlino
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Maccario
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Martino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000648:ultrastructure; D001706:Biopsy; D015314:Dialysis Solutions / Q000009:adverse effects / Q000493:pharmacokinetics; D004848:Epithelium / Q000648:ultrastructure; D005260:Female; D005337:Fibrin / Q000032:analysis; D005347:Fibroblasts / Q000473:pathology; D005355:Fibrosis; D005947:Glucose / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000473:pathology* / Q000503:physiopathology; D012598:Sclerosis; D013997:Time Factors
D015314:Dialysis Solutions; D005337:Fibrin; D005947:Glucose