Encapsulating peritoneal sclerosis: the state of affairs

Korte, Mario R.; Sampimon, Denise E.; Betjes, M.; Krediet, Raymond T.

doi:10.1038/nrneph.2011.93

Cited by 89 publications

(120 citation statements)

References 147 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Although EPS affects a minority (0.9%-3.5%) of patients on long-term PD, it has a mortality rate reaching 50%, resulting from intestinal occlusion, malnutrition, and sepsis. 10 EPS is probably a multifactorial disease, in which PD duration represents an important risk factor. [11][12][13] Other conditions that have been inconsistently associated with EPS include cumulative glucose exposure, younger age, peritonitis episodes, b-blockers, and kidney transplantation.…”

mentioning

confidence: 99%

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

Morelle

Sow

Hautem

et al. 2015

Journal of the American Society of Nephrology

105

View full text Add to dashboard Cite

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD) characterized by extensive fibrosis of the peritoneum. Changes in peritoneal water transport may precede EPS, but the mechanisms and potential predictive value of that transport defect are unknown. Among 234 patients with ESRD who initiated PD at our institution over a 20-year period, 7 subsequently developed EPS. We evaluated changes in peritoneal transport over time on PD in these 7 patients and in 28 matched controls using 3.86% glucose peritoneal equilibration tests. Compared with long-term PD controls, patients with EPS showed early loss of ultrafiltration capacity and sodium sieving before the onset of overt EPS. Multivariate analysis revealed that loss of sodium sieving was the most powerful predictor of EPS. Compared with long-term PD control and uremic peritoneum, EPS peritoneum showed thicker submesothelial fibrosis, with increased collagen density and a greater amount of thick collagen fibers. Reduced osmotic conductance strongly correlated with the degree of peritoneal fibrosis, but not with vasculopathy. Peritoneal fibrosis was paralleled by an excessive upregulation of vascular endothelial growth factor and endothelial nitric oxide synthase, but the expression of endothelial aquaporin-1 water channels was unaltered. Our findings suggest that an early and disproportionate reduction in osmotic conductance during the course of PD is an independent predictor of EPS. This functional change is linked to specific alterations of the collagen matrix in the peritoneal membrane of patients with EPS, thereby validating the serial three-pore membrane/fiber matrix and distributed models of peritoneal transport.

show abstract

mentioning

confidence: 99%

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

Morelle

Sow

Hautem

et al. 2015

Journal of the American Society of Nephrology

105

View full text Add to dashboard Cite

show abstract

“…However, the precise mechanism leading to EPS still remains unknown. The most prominent features of EPS are complete mesothelial denudation and the progressive fibrosis in the parietal and visceral peritoneum [1][2][3][4][5][6]. Peritoneal fibrosis occurs in peritoneal dialysis patients in response to a variety of injuries, including bio-incompatible dialysate solutions, peritonitis, uremia, and chronic inflammation [7].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Systemic Infusion of Bradykinin on Experimental Peritoneal Fibrosis

Yaşar¹,

Uysal²,

Öztop³

et al. 2015

Osmangazi̇ Journal of Medicine

View full text Add to dashboard Cite

Background. Bradykinin (BK) is a proinflammatory peptide that is involved in the inflammation and vascular regulation. Recent studies have indicated that stimulation of BK-B2 receptors may attenuate fibrosis in renal and liver injuries and it is also expressed on neutrophils.Objectives. The aim of this study is to investigate the expression of bradykinin-B2 receptors and to explore the effects of systemic infusion of bradykinin (BK) using histochemical and immunohistochemical methods in a rodent model of chlorhexidine gluconate-induced peritoneal fibrosis.Materials and Methods. In this experimental study, twenty-four male SpragueDawley rats (n=24) were divided into three groups; Control, Chlorhexidine Gluconate (CG) and Chlorhexidine Gluconate+Bradykinin treatment (CG+BK). All animals were euthanized at day 21 and peritoneal tissue samples were taken under anesthesia induced by 50 mg/kg s.c. sodium pentothal. Histological assessments were then performed using hematoxylin and eosin, Periodic Acid-Schiff staining; and antibodies against TGF-β1, MMP-2, PAI-1 and bradykinin-B2 (BK-B2) receptors.Results. Thickness of submesothelial layer, neovascularization, polimorphonuclear granulocytes and fibrosis increased in the CG+BK treatment group. While expression of TGF-β1, MMP-2 and PAI-1 was not significantly different than that of the CG group. Staining of BK-B2 receptors was up-regulated in the submesothelial compact zone of the CG+BK treatment group.Conclusions. The results of our study showed that the stimulation of BK-B2 receptors by systemic BK perfusion did not have any antifibrotic effects in the encapsulating peritoneal sclerosis rat models, and actually, it may even promote fibrosis by aggravating inflammation.

show abstract

“…A diagnosis of EPS can be made when symptoms of obstructed bowel passage are present in combination with characteristic computed tomography (CT) findings (2). In some cases, though, a definite diagnosis of EPS requires surgical exploration.…”

mentioning

confidence: 99%

Localized Encapsulating Peritoneal Sclerosis Constricting the Terminal Ileum—an Unusual Appearance Requiring Surgical Intervention

et al. 2013

Self Cite

View full text Add to dashboard Cite

♦ Background: Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD). It is characterized by encapsulation of the bowel, causing symptoms of intestinal obstruction. Exclusive involvement of parts of the bowel may occur and may be more common than previously thought. Our main objective was to investigate and report on patients with localized EPS. ♦ Methods: Between July 2002 and December 2011, 9 of 17 EPS patients were referred to our department of surgery for a diagnostic laparotomy. Three of the 9 cases showed localized encapsulation of the small bowel and were selected for the purpose of this study. ♦ Results: All 3 patients presented with an acute inflammatory state and symptoms of bowel obstruction. In 2 patients, EPS became clinically overt after kidney transplantation; the third patient was diagnosed while on hemodialysis. All shared a history of PD ranging from 31 to 101 months. In none of the patients was radiologic examination conclusive, although 2 showed peritoneal thickening and ascites. Each patient underwent laparotomy, confirming EPS. In all cases, a thickened peritoneal membrane became apparent, predominantly covering the ileocecal region of the intestine. In addition, a constrictive membrane at the level of the terminal ileum was noted. In 2 cases, the patients underwent enterolysis and dissection of the constricting fibrotic peritoneal membrane (peritonectomy) without bowel resection. The 3rd patient was managed with parenteral nutrition and tamoxifen. The postoperative course in 1 patient was complicated by infected ascites that resolved with antibiotic treatment. Eventually, all patients were doing well, with adequate oral intake and without the need for repeat surgery. ♦ Conclusions: Localized EPS may be more common than previously thought. It has a predilection for the level of the terminal ileum. We believe that an elective diagnostic laparotomy should be considered early, because this procedure offers both diagnostic opportunities and therapeutic options. Localized EPS cases may benefit most from enterolysis and peritonectomy.

show abstract

Encapsulating peritoneal sclerosis: the state of affairs

Cited by 89 publications

References 147 publications

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

The Effects of Systemic Infusion of Bradykinin on Experimental Peritoneal Fibrosis

Localized Encapsulating Peritoneal Sclerosis Constricting the Terminal Ileum—an Unusual Appearance Requiring Surgical Intervention

Contact Info

Product

Resources

About