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Daraghmeh L, Eleiwi M, Qamhia N, Maqboul I. Mechanical Bowel Obstruction Due to Secondary Sclerosing Peritonitis, Managed Conservatively: A Case Report. Cureus 2024; 16:e51683. [PMID: 38313947 PMCID: PMC10838387 DOI: 10.7759/cureus.51683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
An uncommon cause of intestinal obstruction is an abdominal cocoon, also known as sclerosing encapsulating peritonitis (SEP). We present the case of a 24-year-old female peritoneal dialysis patient who presented with a picture of complete intestinal obstruction. After reviewing the patient's medical history and acquiring relevant laboratory and imaging data, the decision was made to proceed with surgery. Intraoperatively, however, she had a picture of sclerosing peritonitis. The decision was to terminate the surgery and to take a conservative approach, including total parenteral nutrition. Her condition improved, obstruction was resolved, and she was discharged home in good clinical condition. Sclerosing peritonitis should be considered a possible etiology that can be managed conservatively in any peritoneal dialysis patient with intestinal obstruction.
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Affiliation(s)
- Laith Daraghmeh
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Naim Qamhia
- Pathology, An-Najah National University Hospital, Nablus, PSE
| | - Iyad Maqboul
- General Surgery, An-Najah National University Hospital, Nablus, PSE
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Muta K, Nakazawa Y, Obata Y, Inoue H, Torigoe K, Nakazawa M, Abe K, Furusu A, Miyazaki M, Yamamoto K, Koji T, Nishino T. An inhibitor of Krüppel-like factor 5 suppresses peritoneal fibrosis in mice. Perit Dial Int 2021; 41:394-403. [PMID: 33522431 DOI: 10.1177/0896860820981322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACK GROUND Krüppel-like transcription factor 5 (KLF5) is a transcription factor regulating cell proliferation, angiogenesis and differentiation. It has been recently reported that Am80, a synthetic retinoic acid receptor α-specific agonist, inhibits the expression of KLF5. In the present study, we have examined the expression of KLF5 in fibrotic peritoneum induced by chlorhexidine gluconate (CG) in mouse and evaluated that Am80, as an inhibitor of KLF5, can reduce peritoneal fibrosis. METHODS Peritoneal fibrosis was induced by intraperitoneal injection of CG into peritoneal cavity of ICR mice. Am80 was administered orally for every day from the start of CG injection. Control mice received only a vehicle (0.5% carboxymethylcellulose solution). After 3 weeks of treatment, peritoneal equilibration test (PET) was performed and peritoneal tissues were examined by immunohistochemistry. RESULTS The expression of KLF5 was less found in the peritoneal tissue of control mice, while KLF5 was expressed in the thickened submesothelial area of CG-injected mice receiving the vehicle. Am80 treatment reduced KLF5 expression and remarkably attenuated peritoneal thickening, accompanied with the reduction of type III collagen expression. The numbers of transforming growth factor β-positive cells, α-smooth muscle actin-positive cells and infiltrating macrophages were significantly decreased in Am80-treated group. PET revealed the increased peritoneal permeability in CG mice, whereas Am80 administration significantly improved the peritoneal high permeability state. CONCLUSIONS These results indicate the involvement of KLF5 in the progression of experimental peritoneal fibrosis and suggest that Am80 may be potentially useful for the prevention of peritoneal fibrosis through inhibition of KLF5 expression.
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Affiliation(s)
- Kumiko Muta
- Department of Nephrology, 88380Nagasaki University Hospital, Japan
| | - Yuka Nakazawa
- Department of Nephrology, Hokusyo Central Hospital, Nagasaki, Japan
| | - Yoko Obata
- Department of Nephrology, 88380Nagasaki University Hospital, Japan.,Medical Education Development Center, 88380Nagasaki University Hospital, Japan
| | - Hiro Inoue
- Department of Nephrology, 88380Nagasaki University Hospital, Japan
| | - Kenta Torigoe
- Department of Nephrology, 88380Nagasaki University Hospital, Japan
| | - Masayuki Nakazawa
- Department of Nephrology, Sasebo City Central Hospital, Nagasaki, Japan
| | | | - Akira Furusu
- Department of Nephrology, Wajinkai Hospital, Nagasaki, Japan
| | | | - Kazuo Yamamoto
- Biomedical Research Support Center, Nagasaki University School of Medicine, Japan
| | - Takehiko Koji
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomoya Nishino
- Department of Nephrology, 88380Nagasaki University Hospital, Japan
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3
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Zhang Y, Nam K, Kimura T, Wu P, Nakamura N, Hashimoto Y, Funamoto S, Kishida A. Preparation of gradient-type biological tissue-polymer complex for interlinking device. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 114:111017. [PMID: 32993989 DOI: 10.1016/j.msec.2020.111017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2019] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the monomer absorption behavior of decellularized dermis and prepare a gradient-type decellularized dermis-polymer complex. Decellularized dermis was prepared using sodium dodecyl sulfate, and its monomer absorption behavior was investigated using three types of hydrophobic monomer with different surface free energies. The results show that monomer absorption depends strongly on the tissue structure, regardless of the surface free energy, and the amount of absorbed monomer can be increased by sonication. Based on these results, we prepared a gradient-type decellularized dermis-poly(methyl methacrylate) complex by controlling the permeation time of the methyl methacrylate monomer and polymerization initiator into the decellularized dermis. The mechanical strength of this complex gradually increased from the dermis side to the polymer side, and combined the physical characteristics of the dermis and the polymer.
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Affiliation(s)
- Yongwei Zhang
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Kwangwoo Nam
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Tsuyoshi Kimura
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Pingli Wu
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Naoko Nakamura
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Yoshihide Hashimoto
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Seiichi Funamoto
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Akio Kishida
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan.
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Mishima Y, Miyazaki M, Abe K, Ozono Y, Shioshita K, Xia Z, Harada T, Taguchi T, Koji T, Kohno S. Enhanced Expression of Heat Shock Protein 47 in Rat Model of Peritoneal Fibrosis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300102] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
← Objective Peritoneal fibrosis is one of the serious complications of continuous ambulatory peritoneal dialysis therapy and is characterized by collagen accumulation. Heat shock protein 47 (HSP-47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis; however, the involvement of HSP-47 in the progression of peritoneal fibrosis is not fully understood. ← Design To examine the serial pathological alterations caused by peritoneal fibrosis, we made an experimental model of peritoneal fibrosis by daily intraperitoneal injection of chlorhexidine gluconate (CG) in rats for 28 days and examined the expression of HSP-47 together with that of types I and III collagen, alpha-smooth muscle actin (αSMA), and ED-1 (a marker for macrophages) using immunohistochemistry. Rats treated with saline containing 15% ethanol were used as the control group. ← Results In the control group, the peritoneal tissue was slightly thickened and HSP-47 was expressed in the peritoneum at day 28. In the CG group, the peritoneal tissue serially became thickened and fibrotic. The expression of HSP-47 was evident in mesothelial cells and submesothelial connective tissue after day 7 of treatment with CG, and increased thereafter. The expression of types I and III collagen and αSMA was proportionally strengthened during our experiments. ED-1–positive cells were present in thickened areas with abundant proliferation of collagen fiber. The number of cells positive for ED-1 increased gradually and reached a maximum at day 21. ← Conclusion Our results indicate that, in a rat experimental model of peritoneal fibrosis, the expression of HSP-47 is associated with the progression of peritoneal fibrosis.
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Affiliation(s)
- Yoko Mishima
- Second Department of Internal Medicine, Nagasaki, Japan
| | | | | | | | - Kei Shioshita
- Second Department of Internal Medicine, Nagasaki, Japan
| | - Zhiyin Xia
- Second Department of Internal Medicine, Nagasaki, Japan
| | | | | | - Takehiko Koji
- Department of Histology and Cell Biology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki, Japan
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Warady BA. Sclerosing Encapsulating Peritonitis: What Approach Should be Taken with Children? Perit Dial Int 2020. [DOI: 10.1177/089686080002000404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bradley A. Warady
- Section of Pediatric Nephrology Children's Mercy Hospitals and Clinics Kansas City, Missouri, U.S.A
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6
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Nakamoto H. Encapsulating Peritoneal Sclerosis—A Clinician's Approach to Diagnosis and Medical Treatment. Perit Dial Int 2020. [DOI: 10.1177/089686080502504s05] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPS is usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue. A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.
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Affiliation(s)
- Hidetomo Nakamoto
- Department of Nephrology, Tokorozawa Kidney Clinic, Tokorozawa, Japan
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Wong CF, Beshir S, Khalil A, Pai P, Ahmad R. Successful Treatment of Encapsulating Peritoneal Sclerosis with Azathioprine and Prednisolone. Perit Dial Int 2020. [DOI: 10.1177/089686080502500312] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christopher F. Wong
- Department of Nephrology Royal Liverpool University Hospital Liverpool, United Kingdom
| | - Salah Beshir
- Department of Nephrology Royal Liverpool University Hospital Liverpool, United Kingdom
| | - Atif Khalil
- Department of Nephrology Royal Liverpool University Hospital Liverpool, United Kingdom
| | - Pearl Pai
- Department of Nephrology Royal Liverpool University Hospital Liverpool, United Kingdom
| | - Rasheed Ahmad
- Department of Nephrology Royal Liverpool University Hospital Liverpool, United Kingdom
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Affiliation(s)
- Carol A. Pollock
- Department of Medicine, Royal North Shore Hospital, Kolling Institute, University of Sydney, Sydney, Australia
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Araki Y, Hataya H, Tanaka Y, Fukuzawa R, Ikeda M, Kawamura K, Honda M. Long-Term Peritoneal Dialysis is a Risk Factor of Sclerosing Encapsulating Peritonitis for Children. Perit Dial Int 2020. [DOI: 10.1177/089686080002000412] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveSclerosing encapsulating peritonitis (SEP) is a clinical syndrome with a high mortality rate and is a serious complication of peritoneal dialysis (PD). Peritoneal sclerosis (PS) is a histological diagnosis. PS is usually observed in the peritoneal specimens of patients with SEP. Avoiding SEP is considered to be extremely important for pediatric patients who may require long-term PD. In this study, the characteristics of patients with PS were investigated to determine when to perform peritoneal biopsies and how long PD can be performed safely.DesignA retrospective single-center study.SettingTokyo Metropolitan Kiyose Children's Hospital.PatientsA total of 109 children younger than 16 years have received chronic PD in our unit since 1981. Among these children, 16 patients had been on PD for more than 5 years (mean 7.4 ± 2.5 years) from May 1992 to March 1999. Peritoneal biopsies were performed in 14 of the 16 patients, who were divided into two groups based on the histological diagnoses: a PS and a peritoneal fibrosis (PF) group.ResultsThe 14 patients were on PD for a mean of 7.8 ± 2.5 years. There were 8 patients with PS and 6 patients with PF. SEP was observed in 2 patients in the PS group. The risk of PS increased with the duration of PD: 57% (8/14) > 5 years, 80% (4/5) > 8 years, and 100% (3/3) > 10 years. All patients in the PS group showed both peritoneal calcifications on abdominal CT scan and poor ultra-filtration at the time of diagnoses.ConclusionLong-term PD was the important risk factor of SEP. If both peritoneal calcification on abdominal CT scan and poor ultrafiltration are observed in a patient on PD more than 5 years, a peritoneal biopsy should be performed. If PS is detected, PD should be discontinued.
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Affiliation(s)
- Yoshinori Araki
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yuriko Tanaka
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuji Fukuzawa
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ikeda
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Kawamura
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, and Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. Encapsulating Peritoneal Sclerosis: Definition, Etiology, Diagnosis, and Treatment. Perit Dial Int 2020. [DOI: 10.1177/089686080002004s04] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yoshindo Kawaguchi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Hideki Kawanishi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Salim Mujais
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Nicholas Topley
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Dimitrios G. Oreopoulos
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
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de Freitas D, Jordaan A, Williams R, Alderdice J, Curwell J, Hurst H, Hutchison A, Brenchley PE, Augustine T, Summers AM. Nutritional Management of Patients Undergoing Surgery following Diagnosis with Encapsulating Peritoneal Sclerosis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800314] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). Gastrointestinal (GI) symptoms affect appetite and dietary intake. Adequate nutrition is especially important if surgical interventions are required.AimTo investigate the nutritional management of 23 EPS patients that underwent surgical intervention between 1999 and 2005 at Manchester Royal Infirmary, United Kingdom.MethodsEPS was recognized by GI symptoms and diagnostically confirmed by laparotomy, computed tomographic scanning, or biopsy.ResultsMean time on PD was 74 months (interquartile range 42 – 89 months). During the 12 months pre-diagnosis, 65% of the group showed significant weight loss ( p = 0.0001), with 8 patients losing >10% of body weight; 74% of patients experienced significant albumin decrease ( p = 0.001); and 56% of patients experienced GI symptoms during the 6 months pre-diagnosis. Nasogastric (NG) feeding was recommended for 8 patients but continued in only 1. 15 patients (mean albumin 27 g/L) commenced parenteral nutrition (PN); 9 patients recovered, with albumin increasing over the 6-month follow-up. Mean hospital time was 62 days for the group receiving neither NG nor PN, compared with 124.3 for the PN/NG group ( p = 0.04). In patients that died of EPS, albumin continued to fall at 3 months post-diagnosis.ConclusionThere is currently little guidance for nutritional management of EPS. From this study we recommend ( 1 ) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; ( 2 ) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; ( 3 ) aggressive nutritional supplementation pre- and postoperatively; and ( 4 ) dietitians need to recognize the high risk of refeeding syndrome.
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Affiliation(s)
- Declan de Freitas
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Antoinette Jordaan
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Rosalind Williams
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jane Alderdice
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Janet Curwell
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Helen Hurst
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Alastair Hutchison
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Paul E.C. Brenchley
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Angela M. Summers
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
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Di Paolo N, Sacchi G, Lorenzoni P, Sansoni E, Gaggiotti E. Ossification of the Peritoneal Membrane. Perit Dial Int 2020. [DOI: 10.1177/089686080402400513] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundPeritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP.ObjectiveTo investigate etiopathogenetic correlations between PO and SP by histopathological examination.MethodWe examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy.ResultsOssification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite.ConclusionsCalcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.
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Affiliation(s)
- Nicola Di Paolo
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
| | - Giovanni Sacchi
- Neuroscience Department, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Paola Lorenzoni
- Neuroscience Department, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Enrico Sansoni
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
| | - Enzo Gaggiotti
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
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Summers AM, Brenchley PEC. An International Encapsulating Peritoneal Sclerosis Registry and DNA Bank: Why We Need One Now. Perit Dial Int 2020. [DOI: 10.1177/089686080602600506] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Angela M. Summers
- Renal Research Laboratories Manchester Institute of Nephrology and Transplantation Manchester Royal Infirmary Manchester, United Kingdom
| | - Paul E. C. Brenchley
- Renal Research Laboratories Manchester Institute of Nephrology and Transplantation Manchester Royal Infirmary Manchester, United Kingdom
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Four Consecutive Cases of Peritoneal Dialysis-Related Encapsulating Peritoneal Sclerosis Treated Successfully with Tamoxifen. Perit Dial Int 2020. [DOI: 10.1177/089686080602600215] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sclerosing peritonitis is a rare complication of peritoneal dialysis (PD). In encapsulating peritoneal sclerosis (EPS), the most severe form of the disease, the intestine is entrapped in a fibrous tissue, causing intestinal obstruction. Patients are typically seriously ill, with evidence of infection and requirement for parenteral nutrition. A mortality rate of 73% has been reported. There is no established medical treatment and surgery has offered variable results. Our unit provides renal replacement therapy for a population of about 2 million. The prevalent population of PD patients averages 110. The cumulative PD population since January 1993 is 643, with an EPS prevalence of 0.6%. Influenced by the first case reported by Allaria in 1999 suggesting benefit of tamoxifen in treating EPS, we have treated with tamoxifen the four consecutive cases of EPS that have presented since 1999. All 4 patients have survived and recovered intestinal function. All showed prior evidence of peritoneal dysfunction with ultrafiltration failure and were characterized by long duration of PD therapy rather than multiple episodes of peritonitis. We conclude that tamoxifen is a highly promising therapy in EPS, hitherto a usually fatal condition. This description of its efficacy in acutely ill patients with EPS complements its possible prophylactic use in patients with the earlier and milder disease, sclerosing peritonitis. A high index of clinical suspicion for sclerosing peritonitis is desirable, perhaps facilitated by routine screening of at-risk patients.
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Jagirdar RM, Bozikas A, Zarogiannis SG, Bartosova M, Schmitt CP, Liakopoulos V. Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options. Int J Mol Sci 2019; 20:ijms20225765. [PMID: 31744097 PMCID: PMC6887950 DOI: 10.3390/ijms20225765] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.
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Affiliation(s)
- Rajesh M. Jagirdar
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Andreas Bozikas
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Sotirios G. Zarogiannis
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
- Department of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
- Correspondence: ; Tel.: +30-2310-994694
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Abstract
Peritoneal sclerosis is an almost invariable consequence of peritoneal dialysis. In most circumstances it is “simple” sclerosis, manifesting clinically with an increasing peritoneal transport rate and loss of ultrafiltration capacity. In contrast, encapsulating peritoneal sclerosis is a life threatening and usually irreversible condition, associated with bowel obstruction, malnutrition and death. It is unknown whether common etiological factors underlie the development of these 2 clinically and pathologically distinct forms of peritoneal sclerosis. The majority of studies to date have investigated factors that contribute to “simple” sclerosis, although it remains possible that similar mechanisms are amplified in patients who develop encapsulated peritoneal sclerosis. The cellular elements that promote peritoneal sclerosis include the mesothelial cells, peritoneal fibroblasts and inflammatory cells. Factors that stimulate these cells to promote peritoneal fibrosis and neoangiogenesis, both inherent in the development of peritoneal sclerosis, include cytokines that are induced by exposure of the peritoneal membrane to high concentrations of glucose, advanced glycation of the peritoneal membrane and oxidative stress. The cumulative exposure to bioincompatible dialysate is likely to have an etiological role as the duration of dialysis correlates with the likelihood of developing peritoneal sclerosis. Indeed peritoneal dialysis using more biocompatible fluids has been shown to reduce the development of peritoneal sclerosis. The individual contribution of the factors implicated in the development of peritoneal sclerosis will only be determined by large scale peritoneal biopsy registries, which will be able to prospectively incorporate clinical and histological data and support clinical decision making.
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Affiliation(s)
- C Pollock
- Royal North Shore Hospital, University of Sydney, St Leonards, NSW 2065 Australia.
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17
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Zavvos V, Buxton AT, Evans C, Lambie M, Davies SJ, Topley N, Wilkie M, Summers A, Brenchley P, Goumenos DS, Johnson TS. A prospective, proteomics study identified potential biomarkers of encapsulating peritoneal sclerosis in peritoneal effluent. Kidney Int 2017; 92:988-1002. [PMID: 28673451 DOI: 10.1016/j.kint.2017.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a potentially devastating complication of peritoneal dialysis (PD). Diagnosis is often delayed due to the lack of effective and accurate diagnostic tools. We therefore examined peritoneal effluent for potential biomarkers that could predict or confirm the diagnosis of EPS and would be valuable in stratifying at-risk patients and driving appropriate interventions. Using prospectively collected samples from the Global Fluid Study and a cohort of Greek PD patients, we utilized 2D SDSPAGE/ MS and iTRAQ to identify changes in the peritoneal effluent proteome from patients diagnosed with EPS and controls matched for treatment exposure. We employed a combinatorial peptide ligand library to compress the dynamic range of protein concentrations to aid identification of low-abundance proteins. In patients with stable membrane function, fibrinogen γ-chain and heparan sulphate proteoglycan core protein progressively increased over time on PD. In patients who developed EPS, collagen-α1(I), γ-actin and Complement factors B and I were elevated up to five years prior to diagnosis. Orosomucoid-1 and a2-HS-glycoprotein chain-B were elevated about one year before diagnosis, while apolipoprotein A-IV and α1-antitrypsin were decreased compared to controls. Dynamic range compression resulted in an increased number of proteins detected with improved resolution of protein spots, compared to the full fluid proteome. Intelectin-1, dermatopontin, gelsolin, and retinol binding protein-4 were elevated in proteome-mined samples from patients with EPS compared to patients that had just commenced peritoneal dialysis. Thus, prospective analysis of peritoneal effluent uncovered proteins indicative of inflammatory and pro-fibrotic injury worthy of further evaluation as diagnostic/prognostic markers.
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Affiliation(s)
- Vasileios Zavvos
- Department of Nephrology, University Hospital of Patras, Patras, Greece; Academic Nephrology Unit and Sheffield Kidney Institute, University of Sheffield, Sheffield, UK
| | - Anthony T Buxton
- Academic Nephrology Unit and Sheffield Kidney Institute, University of Sheffield, Sheffield, UK
| | - Caroline Evans
- Proteomics Unit, Chemical Engineering, University of Sheffield, Sheffield, UK
| | - Mark Lambie
- Institute of Applied Clinical Sciences, Keele University, Keele, UK
| | - Simon J Davies
- Institute of Applied Clinical Sciences, Keele University, Keele, UK
| | - Nicholas Topley
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Martin Wilkie
- Academic Nephrology Unit and Sheffield Kidney Institute, University of Sheffield, Sheffield, UK
| | - Angela Summers
- Kidney Research Laboratories, Manchester Royal Infirmary, Manchester, UK
| | - Paul Brenchley
- Kidney Research Laboratories, Manchester Royal Infirmary, Manchester, UK
| | | | - Timothy S Johnson
- Academic Nephrology Unit and Sheffield Kidney Institute, University of Sheffield, Sheffield, UK.
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18
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Alatab S, Najafi I, Pourmand G, Hosseini M, Shekarchian S. Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients. Ren Fail 2016; 39:32-39. [PMID: 27774831 PMCID: PMC6014288 DOI: 10.1080/0886022x.2016.1244075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995-2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year, p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.
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Affiliation(s)
- Sudabeh Alatab
- a Urology Department, Urology Research Center , Sina Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Iraj Najafi
- b Department of Nephrology, Nephrology Research Center , Shariati Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Gholamreza Pourmand
- a Urology Department, Urology Research Center , Sina Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Mostafa Hosseini
- c Department of Epidemiology and Biostatistics, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Soroosh Shekarchian
- d Department of Regenerative Biomedicine, Cell Sciences Research Center, Royan Institute For Stem Cell Biology and Technology , ACECR , Tehran , Iran
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19
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Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction. Case Rep Med 2016; 2016:8206894. [PMID: 27642301 PMCID: PMC5014933 DOI: 10.1155/2016/8206894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/07/2016] [Indexed: 12/21/2022] Open
Abstract
We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients.
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20
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Abdullah HMA, Shahzad MA, Ullah S, Ullah W. Idiopathic sclerosing encapsulating peritonitis presenting as a right iliac fossa mass in a teenaged girl. BMJ Case Rep 2016; 2016:bcr-2016-214441. [PMID: 27161205 DOI: 10.1136/bcr-2016-214441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare peritoneal condition characterised by a firm and thick membrane that encases a part of or the whole of the small intestine. It can be idiopathic or secondary to a variety of conditions. It usually presents as an acute or subacute small bowel obstruction, however, the presentation can vary. It may be diagnosed by radiology, although definitive diagnosis is by laparoscopy or laparotomy. It is treated by excision of the covering membrane. We report a case of a teenaged girl who presented with abdominal pain and a palpable mass in the right iliac fossa. The patient underwent emergency laparotomy after her work up was inconclusive, and was found to have a case of SEP. The distal ileum and the sigmoid colon appeared to be covered by a thick membrane, which was excised. Follow-up of the patient was unremarkable.
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Affiliation(s)
| | - Muhammad Asim Shahzad
- Department of Internal Medicine, Hayatabad Medical Complex, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sajjad Ullah
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Waqas Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
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21
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Merino Bueno C, Del Rio García L, Bande Fernández JJ, García R, Hidalgo Ordoñez C, Rodríguez-Suárez C, Sánchez-Álvarez JE. Encapsulating peritoneal sclerosis: A review of 3 cases. Nefrologia 2015; 35:588-90. [PMID: 26560397 DOI: 10.1016/j.nefro.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/15/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carmen Merino Bueno
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - Laura Del Rio García
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Raúl García
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carlos Hidalgo Ordoñez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carmen Rodríguez-Suárez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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22
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Abstract
The incidence of end-stage renal disease in children is increasing. Peritoneal dialysis (PD) is the modality of choice in many European countries and is increasingly applied worldwide. PD enables children of all ages to be successfully treated while awaiting the ultimate goal of renal transplantation. The advantages of PD over other forms of renal replacement therapy are numerous, in particular the potential for the child to lead a relatively normal life. Indications for commencing PD, the rationale, preparation of family, technical aspects, and management of complications are discussed.
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Affiliation(s)
- Nia Fraser
- Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Farida K Hussain
- Paediatric Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Roy Connell
- Paediatric Dialysis, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Manoj U Shenoy
- Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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23
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Stefanidis CJ, Shroff R. Encapsulating peritoneal sclerosis in children. Pediatr Nephrol 2014; 29:2093-103. [PMID: 24258273 DOI: 10.1007/s00467-013-2672-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 02/01/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but extremely serious complication of peritoneal dialysis (PD). While EPS has been well recognized in adults on long-term PD, and children can spend many years on PD before a transplant becomes available, only a small number of children with EPS have been described. Two European pediatric registries have recently reported on the prevalence, potential risk factors and outcomes of EPS in children. Although the prevalence of EPS is comparable to that published in adult registries, the outcome of pediatric EPS is significantly better and carries a lower mortality. All studies have shown a greater risk of EPS with a longer dialysis vintage, but it is not known why some individuals are susceptible to EPS development. In this review we discuss current views on the epidemiology, pathogenesis and management strategies for EPS. The hope of the authors is that this review will alert pediatric nephrologists to this rare but extremely serious complication of chronic PD. In the future, collaborative research and the establishment of a pediatric EPS registry may be of importance in helping pediatric nephrologists to recognize the early warning signs of EPS development and thereby to develop strategies for its prevention and optimal management.
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Affiliation(s)
- Constantinos J Stefanidis
- Department of Nephrology, "P. & A. Kyriakou" Children's Hospital of Athens, Thivon and Levadias Str, Goudi, 14562, Athens, Greece,
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24
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Io K, Nishino T, Obata Y, Kitamura M, Koji T, Kohno S. SAHA Suppresses Peritoneal Fibrosis in Mice. Perit Dial Int 2014; 35:246-58. [PMID: 24584598 DOI: 10.3747/pdi.2013.00089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/07/2013] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Long-term peritoneal dialysis causes peritoneal fibrosis in submesothelial areas. However, the mechanism of peritoneal fibrosis is unclear. Epigenetics is the mechanism to induce heritable changes without any changes in DNA sequences. Among epigenetic modifications, histone acetylation leads to the transcriptional activation of genes. Recent studies indicate that histone acetylation is involved in the progression of fibrosis. Therefore, we examined the effect of suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, on the progression of peritoneal fibrosis in mice. METHODS Peritoneal fibrosis was induced by the injection of chlorhexidine gluconate (CG) into the peritoneal cavity of mice every other day for 3 weeks. SAHA, or a dimethylsulfoxide and saline vehicle, was administered subcutaneously every day from the start of the CG injections for 3 weeks. Morphologic peritoneal changes were assessed by Masson's trichrome staining, and fibrosis-associated factors were assessed by immunohistochemistry. RESULTS In CG-injected mice, a marked thickening of the submesothelial compact zone was observed. In contrast, the administration of SAHA suppressed the progression of submesothelial thickening and type III collagen accumulation in CG-injected mice. The numbers of fibroblast-specific protein-1-positive cells and α-smooth muscle actin α-positive cells were significantly decreased in the CG + SAHA group compared to that of the CG group. The level of histone acetylation was reduced in the peritoneum of the CG group, whereas it was increased in the CG + SAHA group. CONCLUSIONS Our results indicate that SAHA can suppress peritoneal thickening and fibrosis in mice through up-regulation of histone acetylation. These results suggest that SAHA may have therapeutic potential for treating peritoneal fibrosis.
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Affiliation(s)
- Kumiko Io
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Tomoya Nishino
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yoko Obata
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Mineaki Kitamura
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Takehiko Koji
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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25
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Hong KD, Bae JH, Jang YJ, Jung HY, Cho JH, Choi JY, Kim CD, Kim YL, Park SH. Encapsulating peritoneal sclerosis: case series from a university center. Korean J Intern Med 2013; 28:587-93. [PMID: 24009455 PMCID: PMC3759765 DOI: 10.3904/kjim.2013.28.5.587] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/18/2012] [Accepted: 07/30/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Encapsulating peritoneal sclerosis (EPS) is an often-fatal complication of long-term peritoneal dialysis (PD). We here report the clinical features of EPS in Korean PD patients from a single university center. METHODS The data were collected retrospectively from 606 PD patients at Kyungpook National University Hospital, between August 2001 and August 2011. The diagnosis of EPS was based on clinical signs and symptoms, and confirmed by radiological findings. RESULTS Eight patients (1.3%, four males) were diagnosed with EPS. The mean age of the patients was 48.5 years (range, 33 to 65). The mean duration of PD was 111.8 months (range, 23 to 186). All patients except for one had three or more episodes of peritonitis. Seven patients were diagnosed with EPS after stopping PD, and only one stayed on PD after initial diagnosis and treatment. Total parenteral nutrition and corticosteroids, in addition to tamoxifen therapy, were used to treat most of the patients, and one patient underwent surgery (adhesiolysis). The overall mortality rate was 50%. CONCLUSIONS EPS is a serious, life-threatening complication in patients on long-term PD. To reduce the incidence and mortality rate of EPS, careful monitoring and early diagnosis is needed.
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Affiliation(s)
- Kyung-Deuk Hong
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Ji Hea Bae
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Yun-Jin Jang
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
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26
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Rumbo C, Zambernardi A, Cabanne A, Rumbo M, Gondolesi G. Sclerosing peritonitis, a rare complication after intestinal transplant. Report of one case successfully treated with adjustment of immunosuppression. Pediatr Transplant 2013; 17:E125-9. [PMID: 23902605 DOI: 10.1111/petr.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2013] [Indexed: 01/01/2023]
Abstract
Sclerosing peritonitis is a complication described in different clinical situations, such as patients that underwent prolonged peritoneal dialysis or renal transplantation with previous history of peritoneal dialysis. The origin of this entity is unclear so far and it is believed that several mechanisms may contribute to its development. The hallmark of sclerosing peritonitis is the continuous accumulation of fibrocollagenous deposits in the intestinal wall and mesenteries causing progressive adhesion of the intestinal loops and mesenteric retraction resulting in intestinal obstruction. Also, it has been described as a rare complication after intestinal transplant that might lead to graft failure. In this report, we describe a case of sclerosing peritonitis after intestinal transplantation that was successfully treated with modifications in the immunosuppressive regime allowing restitution of gastrointestinal transit and intestinal autonomy.
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Affiliation(s)
- Carolina Rumbo
- Instituto de Trasplante Multiorgánico (ITMO), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
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27
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Juric I, Basic–Jukic N, Kes P. First Documented Case of Endometrial Carcinoma in a Patient Treated with Tamoxifen for Encapsulating Peritoneal Sclerosis. Perit Dial Int 2013; 33:338-9. [DOI: 10.3747/pdi.2012.00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- I. Juric
- Department of Nephrology, Arterial Hypertension and Dialysis University Hospital Centre Zagreb Zagreb, Croatia
| | - N. Basic–Jukic
- Department of Nephrology, Arterial Hypertension and Dialysis University Hospital Centre Zagreb Zagreb, Croatia
| | - P. Kes
- Department of Nephrology, Arterial Hypertension and Dialysis University Hospital Centre Zagreb Zagreb, Croatia
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28
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Abouchacra S, Chaaban A, Sajwani S, Bashir M, Beghdash O, Abdulle A. Encapsulating peritoneal sclerosis: a rare complication of peritoneal dialysis in Al-ain, United arab emirates. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2013; 3:22-7. [PMID: 23569460 PMCID: PMC3618055 DOI: 10.1159/000349999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD) with devastating consequences. Although it can occur among patients on PD, it may present long after PD has been discontinued; thus, its diagnosis depends on a high index of suspicion. We present a rare case of EPS in the United Arab Emirates with a protracted course and delays in recognizing the condition until after resolution of the acute attack. This case highlights the need for early identification of risk factors as well as the subtle features of EPS for appropriate diagnosis and perhaps even prevention; this being worth a ton of cure. A review of the literature including the latest evidence-based treatment options is also highlighted.
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Affiliation(s)
- Samra Abouchacra
- Department of Nephrology, United Arab Emirates University, Al-Ain, United Arab Emirates
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29
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Loureiro J, Gónzalez-Mateo G, Jimenez-Heffernan J, Selgas R, López-Cabrera M, Aguilera Peralta A. Are the Mesothelial-to-Mesenchymal Transition, Sclerotic Peritonitis Syndromes, and Encapsulating Peritoneal Sclerosis Part of the Same Process? Int J Nephrol 2013; 2013:263285. [PMID: 23476771 PMCID: PMC3582112 DOI: 10.1155/2013/263285] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/13/2012] [Accepted: 12/31/2012] [Indexed: 02/01/2023] Open
Abstract
Mesothelial-to-mesenchymal transition (MMT) is an autoregulated physiological process of tissue repair that in uncontrolled conditions, such as peritoneal dialysis (PD), can lead to peritoneal fibrosis. The maximum expression of sclerotic peritoneal syndromes (SPS) is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. The SPS includes a wide range of peritoneal fibrosis that appears progressively and is considered as a reversible process, while EPS does not. EPS is a serious complication of PD characterized by a progressive intra-abdominal inflammatory process that results in bridles and severe fibrous tissue formation which cover and constrict the viscera. Recent studies show that transdifferentiated mesothelial cells isolated from the PD effluent correlate very well with the clinical events such as the number of hemoperitoneum and peritonitis, as well as with PD function (lower ultrafiltration and high Cr-MTC). In addition, in peritoneal biopsies from PD patients, the MMT correlates very well with anatomical changes (fibrosis and angiogenesis). However, the pathway to reach EPS from SPS has not been fully and completely established. Herein, we present important evidence pointing to the MMT that is present in the initial peritoneal fibrosis stages and it is perpetual over time, with at least theoretical possibility that MMT initiated the fibrosing process to reach EPS.
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Affiliation(s)
- Jesús Loureiro
- Centro de Biología Molecular Severo Ochoa, CSIC-UAM, Campus de Cantoblanco, Calle de Nicolás Cabrera 1, 28049 Madrid, Spain
| | - Guadalupe Gónzalez-Mateo
- Servicio de Nefrología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José Jimenez-Heffernan
- Servicio de Anatomía Patológica, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Calle de Diego de León 62, 28006 Madrid, Spain
| | - Rafael Selgas
- Servicio de Nefrología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Manuel López-Cabrera
- Centro de Biología Molecular Severo Ochoa, CSIC-UAM, Campus de Cantoblanco, Calle de Nicolás Cabrera 1, 28049 Madrid, Spain
| | - Abelardo Aguilera Peralta
- Unidad de Biología Molecular and Servicio de Nefrología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Calle de Diego de León 62, 28006 Madrid, Spain
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30
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Hirose M, Nishino T, Obata Y, Nakazawa M, Nakazawa Y, Furusu A, Abe K, Miyazaki M, Koji T, Kohno S. 22-Oxacalcitriol prevents progression of peritoneal fibrosis in a mouse model. Perit Dial Int 2012; 33:132-42. [PMID: 23032084 DOI: 10.3747/pdi.2011.00234] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Vitamin D plays an important role in calcium homeostasis and is used to treat secondary hyperparathyroidism among dialysis patients. The biologic activity of vitamin D and its analogs is mediated by vitamin D receptor (VDR), which is distributed widely throughout the body. Recent papers have revealed that low vitamin D levels are correlated with severe fibrosis in chronic diseases, including cystic fibrosis and hepatitis. The aim of the present study was to evaluate the protective effects of vitamin D against the progression of peritoneal fibrosis. METHODS Peritoneal fibrosis was induced by injection of chlorhexidine gluconate (CG) into the peritoneal cavity of mice every other day for 3 weeks. An analog of vitamin D, 22-oxacalcitriol (OCT), was administered subcutaneously daily from initiation of the CG injections. The peritoneal tissue was excised at 3 weeks. Changes in morphology were assessed by hematoxylin and eosin staining. Expression of VDR, alpha smooth muscle actin (as a marker of myofibroblasts), type III collagen, transforming growth factor β(TGF-β), phosphorylated Smad2/3, F4/80 (as a marker of macrophages), and monocyte chemoattractant protein-1 (MCP-1) was examined by immunohistochemistry. Southwestern histochemistry was used to detect activated nuclear factor κB (NF-κB). RESULTS In the CG-injected mice, immunohistochemical analysis revealed expression of VDR in mesothelial cells, myofibroblasts, and macrophages in the thickened submesothelial zone. Treatment with OCT significantly prevented peritoneal fibrosis and reduced the accumulation of type III collagen in CG-treated mice. Among the markers of fibrosis, the numbers of myofibroblasts, cells positive for TGF-β, and cells positive for phosphorylated Smad2/3 were significantly decreased in the OCT-treated group compared with the vehicle-treated group. Furthermore, OCT suppressed inflammatory mediators of fibrosis, as shown by the reduced numbers of activated NF-κB cells, macrophages, and MCP-1-expressing cells. CONCLUSIONS Our results indicate that OCT attenuates peritoneal fibrosis, an effect accompanied by reduced numbers of myofibroblasts, infiltrating macrophages, and TGF-β-positive cells, suggesting that vitamin D has potential as a novel therapeutic agent for preventing peritoneal sclerosis.
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Affiliation(s)
- Misaki Hirose
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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Latus J, Ulmer C, Fritz P, Rettenmaier B, Biegger D, Lang T, Ott G, Scharpf C, Kimmel M, Steurer W, Alscher MD, Braun N. Encapsulating peritoneal sclerosis: a rare, serious but potentially curable complication of peritoneal dialysis–experience of a referral centre in Germany. Nephrol Dial Transplant 2012; 28:1021-30. [DOI: 10.1093/ndt/gfs159] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chuang SH, Yang WC, Yang CY, Li SY. Encapsulating peritoneal sclerosis and aortic calcification with near-total occlusion. J Emerg Med 2012; 42:695-697. [PMID: 20692787 DOI: 10.1016/j.jemermed.2010.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/29/2010] [Accepted: 05/09/2010] [Indexed: 05/29/2023]
Affiliation(s)
- Sung-Hua Chuang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon. World J Gastroenterol 2012; 18:1999-2004. [PMID: 22563185 PMCID: PMC3342596 DOI: 10.3748/wjg.v18.i17.1999] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.
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Sclerosing peritonitis: a rare but fatal complication of peritoneal inflammation. Mediators Inflamm 2012; 2012:709673. [PMID: 22619486 PMCID: PMC3349264 DOI: 10.1155/2012/709673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/22/2012] [Indexed: 12/19/2022] Open
Abstract
Sclerosing peritonitis is a rare form of peritoneal inflammation with an often fatal outcome. The major risk factor of sclerosing peritonitis is peritoneal dialysis treatment but it can also occur following renal or liver transplantation or be associated with certain drug treatment. This article gives an overview of reasons and treatment options for sclerosing peritonitis and shows a summery of current literature about sclerosing peritonitis.
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A rare cause of small bowel obstruction: Abdominal cocoon. Int J Surg Case Rep 2012; 3:272-4. [PMID: 22522743 DOI: 10.1016/j.ijscr.2012.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The clinical manifestations of abdominal 'cocoon' are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel. PRESENTATION OF CASE A 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal 'cocoon' which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up. DISCUSSION Abdominal 'cocoon' is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively. CONCLUSION Abdominal 'cocoon' should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.
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Korte MR, Sampimon DE, Betjes MGH, Krediet RT. Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol 2011; 7:528-38. [PMID: 21808281 DOI: 10.1038/nrneph.2011.93] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD) with a 50% mortality rate. EPS is characterized by progressive and excessive fibrotic thickening of the peritoneum, leading to encapsulation of the bowels and intestinal obstruction. At present, EPS cannot be detected with certainty during its early stages; however, a progressive loss of ultrafiltration capacity often precedes its development. Studies that attempted to elucidate the pathogenesis of EPS have shown that the duration of exposure to PD fluids is the most important risk factor for EPS, and that young age and possibly the effects of peritonitis are additional contributory factors. The pathophysiology of EPS is probably best described as a multiple-hit process with a central role for transforming growth factor β. A form of EPS that develops shortly after kidney transplantation has also been recognized as a distinct clinical entity, and may be a common form of EPS in countries with a high transplantation rate. Criteria have been developed to identify EPS by abdominal CT scan at the symptomatic stage, but further clinical research is needed to identify early EPS in asymptomatic patients, to clarify additional risk factors for EPS and to define optimal treatment strategies.
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Affiliation(s)
- Mario R Korte
- Albert Schweitzer Hospital, Department of Internal Medicine, PO Box 444, 3300 AK Dordrecht, The Netherlands.
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Adamidis KN, Zachariou CA, Kopaka ME, Charitaki EE, Drakopoulos V, Kara P, Drakopoulos S, Apostolou T. Sclerosing peritonitis presenting 2 years after renal transplantation in a former CAPD patient. Ren Fail 2011; 33:246-8. [PMID: 21332349 DOI: 10.3109/0886022x.2011.552147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sclerosing peritonitis (SP) is a rare but serious complication of peritoneal dialysis (PD), characterized by a fibrous peritoneal thickening. The etiology of this condition remains unknown but is likely to be multifactorial. Patients with SP almost invariably develop ultrafiltration and clearance failure. Although a number of pharmacologic drug treatment options have been tried with various results, surgical treatment and cessation of PD are almost always necessary and transfer to hemodialysis is the only practical option. Despite some evidence supporting the recovery of gastrointestinal function after renal transplantation in such patients, SP may very rarely appear much later after the cessation of PD and even after renal transplantation. We report an interesting case of a former PD patient who 2 years after renal transplantation presented with abdominal discomfort, vomiting, and malnutrition due to SP. Despite the initial conservative treatment, the symptoms persisted and a surgical treatment was decided upon. After that the patient recovered with no further complications. Although the appearance of SP after renal transplantation is extremely rare, it must be included in the differential diagnosis of every case of unexplained malnutrition and abdominal obstruction in a patient with a PD history.
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Korte MR, Sampimon DE, Lingsma HF, Fieren MW, Looman CW, Zietse R, Weimar W, Betjes MG, Boer W, van den Dorpel M, van Ittersum RF, Konings C, Krediet R, de Sevaux R, Zanen A. Risk Factors Associated with Encapsulating Peritoneal Sclerosis in Dutch Eps Study. Perit Dial Int 2011; 31:269-78. [DOI: 10.3747/pdi.2010.00167] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD) with a multifactorial pathophysiology and possible increasing incidence. The aim of the present study was to evaluate the independent associations of PD duration, age, dialysis fluids, and kidney transplantation with EPS. Methods A multicenter case–control study was performed in the Netherlands from 1 January 1996 until 1 July 2007. The population comprised 63 patients with EPS and 126 control patients. Control patients were selected from the national registry and were matched for date of PD start. Associations were analyzed using a log linear regression model. Primary outcome was appearance of EPS. Results Compared with control patients, patients with EPS were younger at the start of PD (34.7 ± 15.4 years vs. 51.5 ± 14.7 years, p < 0.0001). The cumulative period on PD was longer in EPS patients than in control patients (78.7 ± 37.8 months vs. 32.8 ± 24 months, p < 0.0001), and the cumulative period on icodextrin was also longer in EPS patients (32.7 ± 23.3 months vs. 18.1 ± 15.7 months, p = 0.006). Compared with control patients, more EPS patients underwent kidney transplantation (47 vs. 59, p < 0.0001). With regard to the period after transplantation, the yearly probability of EPS increased in the year after transplantation to 7.5% from 1.75%. In multivariate regression analysis, cumulative PD duration, age at PD start, transplantation, time from last transplantation to EPS, calendar time, time on icodextrin, and ultrafiltration failure were independently associated with EPS. Transfer from PD to hemodialysis for reasons other than suspected EPS could not be identified as a risk factor for EPS. Conclusions Duration of PD, age at PD start, kidney transplantation, time since last transplantation, ultrafiltration failure, and time on icodextrin were associated with a higher risk of EPS.
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Affiliation(s)
- Mario R. Korte
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Denise E. Sampimon
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam
| | | | - Marien W. Fieren
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Robert Zietse
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Willem Weimar
- Department of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | | | | | | | | | | | - A.L. Zanen
- Deventer Hospital, Deventer, Netherlands
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Kushiyama T, Oda T, Yamada M, Higashi K, Yamamoto K, Oshima N, Sakurai Y, Miura S, Kumagai H. Effects of liposome-encapsulated clodronate on chlorhexidine gluconate-induced peritoneal fibrosis in rats. Nephrol Dial Transplant 2011; 26:3143-54. [DOI: 10.1093/ndt/gfr068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Encapsulating peritoneal sclerosis: a single-center experience and review of the literature. Int Urol Nephrol 2010; 43:519-26. [PMID: 20924672 DOI: 10.1007/s11255-010-9848-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 09/09/2010] [Indexed: 12/18/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a serious and often fatal complication of long-term PD with severe malnutrition and poor prognosis. It causes progressive obstruction and encapsulation of the bowel. This retrospective study reviews our experience and that reviewed in the literature concerning EPS. It refers to a total of 1966 patients treated with chronic PD between 1974 and 2008. Twenty one of them (1.1%) developed EPS, with the incidence increasing with the duration of PD. Mean age of our patients with EPS was 43, ranging from 18 to 71 years, 8 were men and 13 women with a mean body mass index (BMI) of 21.6 kg/m(2). Only one patient had Type II diabetes, 15 patients had glomerular disease, and six of these 15 had an autoimmune disease such as Wegener's granulomatosis and SLE. Thirteen patients developed EPS while on PD, 7 within 2 years after transfer to HD, and only one after renal transplantation. However, 7 patients had a previous renal transplant before returning to PD and subsequently developing EPS. Interestingly, we did not observe more episodes of EPS after transplantation. In the patients who developed EPS, the peritonitis rate over the period of observation was 1/15.6 pt-months and was due to Staphylococcus aureus, coagulase-negative staphylococcus, Pseudomonas and fungi. A history of peritonitis was not a prerequisite for developing EPS, since one patient had no episodes of peritonitis and 4 had just one previous episode. Fifteen patients presented with peritonitis within 4 months before the diagnosis of EPS with particularly virulent micro-organisms such as S. aureus, Candida, Pseudomonas, Corynebacterium, and Peptostreptococcus. Eleven patients were treated with hypertonic dextrose solutions (4.25 g/dl of dextrose) and seven with icodextrin, indirectly suggesting problems with ultrafiltration. Nine of 21 patients were on beta-blockers. The diagnosis of EPS was made either surgically or radiologically with signs of small bowel obstruction in combination with severe malnutrition. Eleven of our patients (52%) had evidence of small bowel obstruction and 14 patients required total parenteral nutrition (TPN). Tamoxifen (10-20 mg daily) was started in 6 patients, 4 of whom are alive and 2 deceased 3 and 5 years after EPS was diagnosed. Of the 12 patients who were not given tamoxifen, 2 are alive and 10 died. No side effects of tamoxifen were reported. Only 7 of our patients (33%) died during the first year after the diagnosis of EPS. Currently, 4 patients are on HD and 3 have had a renal transplant. Six patients of the fourteen who underwent surgery (42.8%) died within the first 6 months after operation and five died after an average of 6.6 years, mostly due to cardiovascular causes, three are still alive. As EPS becomes more prevalent with longer duration of PD, large multicenter prospective studies are needed to establish its incidence and identify risk factors, therapeutic approach, and prognosis.
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Sampimon DE, Coester AM, Struijk DG, Krediet RT. The time course of peritoneal transport parameters in peritoneal dialysis patients who develop encapsulating peritoneal sclerosis. Nephrol Dial Transplant 2010; 26:291-8. [PMID: 20566569 DOI: 10.1093/ndt/gfq343] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). The first aim was to analyse the risk of EPS in patients who had developed ultrafiltration failure (UFF). The second aim was to identify specific peritoneal transport alterations that distinguish patients with UFF from patients who will develop EPS. METHODS All patients of this study were treated with PD between July 1995 and December 2008 in the Academic Medical Center, Amsterdam, the Netherlands. Risk analysis: all PD patients who developed UFF after at least 2 years of PD. Peritoneal transport analysis: all patients who had PD for at least 55 months were included: 12 EPS patients, 21 patients with UFF and 26 patients with normal ultrafiltration (UF). The peritoneal function was measured yearly with a standard peritoneal permeability analysis. UFF was defined as net UF < 400 mL after a 4-h dwell with a 3.86% dialysis solution. RESULTS Risk analysis: Of the 48 UFF patients, 10 eventually developed EPS. Fifty percent of the patients who continued PD for more than 3 years after the establishment of UFF developed EPS. Peritoneal function analysis: No differences were present for the time courses of solute transport and fluid transport between the EPS and the UFF groups. Overall, the EPS and normal UF groups had lower values for the effective lymphatic absorption rate (ELAR) than the UFF group. CONCLUSIONS The risk of EPS increases with continuation of PD while UFF is present. Transport characteristics are similar between EPS patients and UFF patients without this complication. A constantly low ELAR may distinguish the EPS patients from those with UFF only.
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Affiliation(s)
- Denise E Sampimon
- Department of Internal Medicine, Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Al Saied G, Hassan AZ, Ossip M, Hassan AZ. Idiopathic sclerosing encapsulating peritonitis. Case report and review of literature. Eur Surg 2010. [DOI: 10.1007/s10353-010-0506-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Encapsulating peritoneal sclerosis is a complication of peritoneal dialysis characterized by persistent, intermittent, or recurrent adhesive bowel obstruction. Here we examined the incidence, predictors, and outcomes of encapsulating peritoneal sclerosis (peritoneal fibrosis) by multivariate logistic regression in incident peritoneal dialysis patients in Australia and New Zealand. Matched case-control analysis compared the survival of patients with controls equivalent for age, gender, diabetes, and time on peritoneal dialysis. Of 7618 patients measured over a 13-year period, encapsulating peritoneal sclerosis was diagnosed in 33, giving an incidence rate of 1.8/1000 patient-years. The respective cumulative incidences of peritoneal sclerosis at 3, 5, and 8 years were 0.3, 0.8, and 3.9%. This condition was independently predicted by younger age and the duration of peritoneal dialysis, but not the rate of peritonitis. Twenty-six patients were diagnosed while still on peritoneal dialysis. Median survival following diagnosis was 4 years and not statistically different from that of 132 matched controls. Of the 18 patients who died, only 7 were attributed directly to peritoneal sclerosis. Our study shows that encapsulating peritoneal sclerosis is a rare condition, predicted by younger age and the duration of peritoneal dialysis. The risk of death is relatively low and not appreciably different from that of competing risks for mortality in matched dialysis control patients.
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PERL J, BARGMAN JM, CHAN CT. Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner. Hemodial Int 2009; 13:446-52. [DOI: 10.1111/j.1542-4758.2009.00408.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Diagnosis and treatment of abdominal cocoon: a report of 24 cases. Am J Surg 2009; 198:348-53. [DOI: 10.1016/j.amjsurg.2008.07.054] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Revised: 07/25/2008] [Accepted: 07/25/2008] [Indexed: 12/17/2022]
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Vlijm A, Stoker J, Bipat S, Spijkerboer AM, Phoa SS, Maes R, Struijk DG, Krediet RT. Computed Tomographic Findings Characteristic for Encapsulating Peritoneal Sclerosis: A Case-Control Study. Perit Dial Int 2009. [DOI: 10.1177/089686080902900508] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS. Methods We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3). Results We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls ( p ≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3. Conclusion CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.
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Affiliation(s)
| | - Jaap Stoker
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Shandra Bipat
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Anje M. Spijkerboer
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Saffire S.K.S. Phoa
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Robbert Maes
- Department of Radiology, Gemini Hospital, Den Helder
| | - Dirk G. Struijk
- Division of Nephrology, The Netherlands
- Dianet Foundation, Utrecht–Amsterdam, The Netherlands
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Di Leo A, Busetti R, Pusiol T, Piscioli F, Franceschetti I, Ricci F. Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis. Clin J Gastroenterol 2009; 2:178-182. [PMID: 26192291 DOI: 10.1007/s12328-009-0066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 01/23/2009] [Indexed: 11/25/2022]
Abstract
We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.
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Affiliation(s)
- Alberto Di Leo
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy.
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Arco Hospital, Arco (TN), Italy
| | - Teresa Pusiol
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Piscioli
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Ilaria Franceschetti
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Ricci
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy
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Saito H, Kitamoto M, Kato K, Liu N, Kitamura H, Uemura K, Nogaki F, Takeda T, Mori N, Ono T. Tissue Factor and Factor V Involvement in Rat Peritoneal Fibrosis. Perit Dial Int 2009. [DOI: 10.1177/089686080902900320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Fibrin deposition on the peritoneum has been frequently observed in peritoneal fibrosis induced by long-term peritoneal dialysis. The present study was conducted to clarify the contribution of factor Xa through tissue factor and factor V expression in peritoneal fibrosis. Methods Wistar rats were intraperitoneally injected with chlorhexidine gluconate (CG) every day. For the interventional study, the factor Xa inhibitor fondaparinux was subcutaneously administered. After 28 days of CG injection, peritoneal specimens were examined by immunohistochemical analyses and in situ hybridization. Results The peritoneal submesothelial compact zone was observed to be markedly thicker in the CG-injected groups than in the normal group, and that thickness was dose dependent. Immunohistochemical study revealed massive fibrin, fibronectin, and type IV collagen depositions in the CG-injected groups, which was markedly higher than that in the normal group. Macrophage infiltration and staining for tissue factor, factor V, factor X, and protease-activated receptor-2 were intense in the CG-injected groups and negative/trace in the normal group. Tissue factor and factor V mRNAs were abundant in cells in the thickened peritoneum. A double-labeling experiment revealed that tissue factor was observed mainly in macrophages, and factor V was abundantly distributed in the fibrotic tissue together with macrophages. Fondaparinux treatment decreased the thickness of submesothelial fibrotic tissue, and size and number of CD31-positive vessels. Conclusion These results suggest that expression of tissue factor and factor V in infiltrated macrophages, together with factor X deposition, may progress angiogenesis and accumulation of extracellular matrix components, partly via profibrotic and procoagulant mechanisms in the peritoneum after inflammatory stimulation.
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Affiliation(s)
- Hiroki Saito
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Masayuki Kitamoto
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Kozue Kato
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Ning Liu
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Hisayo Kitamura
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Kazuhide Uemura
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
| | - Fumiaki Nogaki
- Division of Nephrology, Shimada Municipal Hospital, Shizuoka
| | | | - Noriko Mori
- Division of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takahiko Ono
- Division of Molecular Medicine, University of Shizuoka School of Pharmaceutical Sciences
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Kropp J, Sinsakul M, Butsch J, Rodby R. Laparoscopy in the Early Diagnosis and Management of Sclerosing Encapsulating Peritonitis. Semin Dial 2009; 22:304-7. [DOI: 10.1111/j.1525-139x.2008.00546.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lafrance JP, Létourneau I, Ouimet D, Bonnardeaux A, Leblanc M, Mathieu N, Pichette V. Successful Treatment of Encapsulating Peritoneal Sclerosis With Immunosuppressive Therapy. Am J Kidney Dis 2008; 51:e7-10. [DOI: 10.1053/j.ajkd.2007.07.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 07/21/2007] [Indexed: 11/11/2022]
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