Absence of gadolinium deposits in the peritoneal membrane of patients with encapsulating peritoneal sclerosis.
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.
Goffin
Eric
E
Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium. eric.goffin@uclouvain.be
Schroeder
Josef A
JA
Weingart
Christian
C
Decleire
Pierre-Yves
PY
Cosyns
Jean-Pierre
JP
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*
D003287:Contrast Media; D019786:Gadolinium DTPA