title: Absence of gadolinium deposits in the peritoneal membrane of patients with encapsulating peritoneal sclerosis.
abstract: Background. Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD) characterized by the development of an extensive fibrosis of the visceral peritoneum that may eventually lead to intestinal constriction. Its cause remains elusive. Nephrogenic systemic fibrosis (NSF), a disabling disease that can follow gadolinium-based contrast injection during magnetic resonance imaging, is characterized by systemic fibrosis of the skin, joints, liver, heart and vessels. Affected tissues are infiltrated by CD34+ and CD68+ fibroblasts. In the present study, we tested the hypothesis that EPS could have been triggered by a previous gadolinium injection. Methods. We performed histopathological analysis of the peritoneal membrane of two EPS and two control patients all exposed to long-term PD, including immunostaining with CD34 and CD68. The presence of gadolinium and other metals was also assessed by conventional and energy-filtered transmission electron microscopy.
  
  
  RESULTS
  Numerous CD34+ and CD68+ cells were found in both the EPS and control patients within the vascular endothelium and in macrophages, respectively, but not in interstitial fibrocytes, as it could be expected in NSF. No trace of gadolinium deposits could be found in the four peritoneal samples; dispersed tiny iron inclusions were evidenced in the connective tissue of both EPS patients.
  
  
  CONCLUSIONS
  These findings argue against the implication of gadolinium in the development of EPS in long-term PD patients.
authors.affiliation: Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium. eric.goffin@uclouvain.be
authors.forename: Eric
authors.initials: E
authors.lastname: Goffin
authors.forename: Josef A
authors.initials: JA
authors.lastname: Schroeder
authors.forename: Christian
authors.initials: C
authors.lastname: Weingart
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Decleire
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cosyns
mesh_terms: D000328:Adult; D002462:Cell Membrane / Q000473:pathology*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000150:complications*; D010537:Peritoneum / Q000187:drug effects / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA