Document Detail

Quantitative evaluation and assessment of peritoneal morphologic changes in peritoneal dialysis patients.
MedLine Citation:
PMID:  20466666     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Morphologic changes of the peritoneum such as peritoneal fibrosis and vasculopathy develop during peritoneal dialysis (PD). In 2002, Williams et al. reported microscopic characteristics of peritoneal changes in PD patients. These studies pointed out the importance of establishing a global standard for qualitative and quantitative histological evaluations. The objectives of the present study are (i) to verify the methods for assessing peritoneal thickness and classifying vasculopathy in peritoneal specimens using the assessment of Williams et al. and (ii) to propose a simple assessment that reflects clinical features such as PD duration and peritoneal function.
METHODS: Parietal peritoneal samples were obtained from 35 patients that included 27 patients with PD and 8 uraemic patients without PD. In all samples, the maximum and average thicknesses of the submesothelial compact (SMC) zone were measured to assess peritoneal interstitial fibrosis using KS400 imaging analysis. Vasculopathy was also assessed by calculation of patency rates of the vascular lumens using the diameter and area, and by measurement of dimensions of vascular wall hyalinization in each vessel specimen.
RESULTS: The median values of maximum and average thicknesses of the SMC zone exceeded 200 μm in uraemic patients without PD treatment. There was a significant relationship between the maximum and average thicknesses of the SMC zone (P < 0.0001). Four to 30 vessels were examined in each participant. Various grades of vasculopathy were observed in each specimen. According to the predominant vasculopathy found in each vessel, the prevalence of serious vasculopathy increased with increasing PD duration. Vascular patency calculated from wall thickness was significantly related to that calculated by the area and to the thickness of hyalinization. Average vascular patency assessed from 5 to 10 vessels in each patient having diameters ranging from 10 to 40 μm was related to PD duration and to peritoneal function (D4/P).
CONCLUSIONS: A random-points measurement of average SMC thickness provides a descriptive evaluation of the severity of peritoneal fibrosis that minimizes artefacts during processing and avoids human error. In addition, the average patency in post-capillary venules appears to accurately reflect clinical features such as PD duration and peritoneal permeability.
Tetsutaro Shimaoka; Chieko Hamada; Kayo Kaneko; Hiroaki Io; Yoshimi Sekiguchi; Seiki Aruga; Jiro Inuma; Yuko Inami; Yoko Hotta; Satoshi Horikoshi; Toshio Kumasaka; Yasuhiko Tomino
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Publication Detail:
Type:  Journal Article     Date:  2010-04-22
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  25     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-23     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  3379-85     Citation Subset:  IM    
Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
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MeSH Terms
Middle Aged
Peritoneal Dialysis / adverse effects*
Peritoneum / blood supply,  pathology*
Vascular Diseases / etiology
Vascular Patency

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