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Morphologic changes in the peritoneal membrane of patients with renal disease

Williams, John David, Craig, Kathrine Jane, Topley, Nicholas, Von Ruhland, Christopher John, Fallon, Maureen, Newman, Geoffrey Richard, MacKenzie, Ruth Kathryn and Williams, Geraint Trefor 2002. Morphologic changes in the peritoneal membrane of patients with renal disease. Journal of the American Society of Nephrology 13 (2) , pp. 470-479.

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This study examined the morphologic features of the parietal peritoneal membranes of 130 patients undergoing peritoneal dialysis (PD) and compared them with the features of the peritoneal membranes of normal individuals, uremic predialysis patients, and patients undergoing hemodialysis. The median thickness of the submesothelial compact collagenous zone was 50 µm for normal subjects, 140 µm for uremic patients, 150 µm for patients undergoing hemodialysis, and 270 µm for patients undergoing PD (P < 0.001 for all versus normal subjects). Compact zone thickness increased significantly with the duration of PD therapy [0 to 24 mo, 180 µm (n = 58); 25 to 48 mo, 240 µm (n = 24); 49 to 72 mo, 300 µm (n = 13); 73 to 96 mo, 750 µm (n = 16); >97 mo, 700 µm (n = 19)]. Vascular changes included progressive subendothelial hyalinization, with luminal narrowing or obliteration. These changes were absent in samples from normal subjects but were present in 28% of samples from uremic patients and 56% of biopsies from patients undergoing PD. In the PD group, the prevalence of vasculopathy increased significantly with therapy duration (P = 0.0001). The density of blood vessels per unit length of peritoneum was significantly higher for patients with membrane failure and was correlated with the degree of fibrosis (P = 0.01). For the first time, a comprehensive cross-sectional analysis of the morphologic changes in the peritoneal membranes of patients undergoing PD is provided. The infrequency of fibrosis in the absence of vasculopathy suggests that vasculopathy may predispose patients to the development of fibrosis. This study provides a sufficiently large cohort of samples to allow structure-function relationships to be established, as well as providing a repository of tissue for further studies.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Publisher: Lippincott, Williams & Wilkins
ISSN: 1046-6673
Last Modified: 30 Jun 2017 01:31

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