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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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2
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Fieren MW, Betjes MG, Korte MR, Boer WH. Posttransplant Encapsulating Peritoneal Sclerosis: A Worrying New Trend? Perit Dial Int 2020. [DOI: 10.1177/089686080702700603] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in patients on peritoneal dialysis (PD). We describe a cluster of 13 EPS cases occurring in 2 university hospitals in The Netherlands. Most of these cases were diagnosed after recent kidney transplantation, when the patients developed severe symptoms of bowel obstruction. This accumulation raised the question as to whether other than known risk factors, such as duration of PD treatment, could be involved in the development or course of EPS after transplantation. According to various publications, EPS has been diagnosed often after withdrawal from PD, suggesting that cessation in itself may be a risk factor. In addition, transplantation-related management should be considered to play a role, including the use of the profibrotic calcineurin inhibitors and the trend to reduce the load of corticosteroids in treatment regimes. To identify risk factors, further multicenter studies are required, paying special attention to alterations in immunosuppressive treatment regimens as well as PD prescriptions, including PD fluid characteristics. Transfer from PD to hemodialysis should be under serious consideration in patients eligible for kidney transplantation as soon as there are indications of ultrafiltration failure.
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Affiliation(s)
| | - Michiel G.H. Betjes
- Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam
| | - Mario R. Korte
- Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam
| | - Walther H. Boer
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
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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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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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6
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Goodlad C, Tam FWK, Ahmad S, Bhangal G, North BV, Brown EA. Dialysate cytokine levels do not predict encapsulating peritoneal sclerosis. Perit Dial Int 2014; 34:594-604. [PMID: 24584593 DOI: 10.3747/pdi.2012.00305] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD). There is no well-validated method for predicting which patients will develop the condition, although known risk factors include long duration of PD, high glucose exposure and lack of residual renal function. We have investigated whether dialysate cytokines (MCP-1 (monocyte chemotactic protein-1), CCL18 (pulmonary and activation-regulated cytokine, PARC), IL-6 (interleukin-6), CCL15 (leukotactin) and angiogenin) could be used to predict the onset of EPS more effectively than known clinical risk factors. METHODS Samples of dialysate and clinical data were prospectively collected from 151 patients at the West London Renal center between 2003 and 2010. Dialysate cytokine levels were measured using the enzyme-linked immunoabsorbant assay (ELISA) technique. Encapsulating peritoneal sclerosis subsequently developed in 17 patients during a follow-up period of 27 - 113 months. Cytokines found at higher levels in dialysate of pre-EPS patients were investigated as candidate predictors of EPS using logistic regression analysis. RESULTS Dialysate IL-6, MCP-1 and CCL15 were significantly higher in patients who subsequently developed EPS; however, a logistic regression model using dialysate cytokines to predict EPS was no better than a model using well-recognized clinical markers (length of time on PD and membrane transport status). CONCLUSIONS Although MCP-1, IL-6 and CCL15 were found at higher levels in the dialysate of patients who subsequently developed EPS, dialysate levels of these cytokines do not improve prediction of future EPS above a model using known clinical risk factors.
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Affiliation(s)
- Catriona Goodlad
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Frederick W K Tam
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Sohail Ahmad
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Gurjeet Bhangal
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Bernard V North
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
| | - Edwina A Brown
- Renal Section, Department of Medicine, Imperial College, London, United Kingdom; and Senior Statistician, Queen Mary University of London, London, United Kingdom
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7
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Abstract
Would you recognize this condition?
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Affiliation(s)
- D van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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8
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Summers AM, Abrahams AC, Alscher MD, Betjes M, Boeschoten EW, Braun N, Brenchley PEC, Davies S, Dunn L, Engelsman L, Fieren M, Garosi G, Goffin E, Heuveling L, Korte M, Lindholm B, Rutherford P, Struijk D, Verduijn M, Verger C, Westerhuis R. A collaborative approach to understanding EPS: the European perspective. Perit Dial Int 2012; 31:245-8. [PMID: 21555409 DOI: 10.3747/pdi.2010.00086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Angela M Summers
- Department of Renal Research, Manchester Royal Infirmary, Manchester, UK.
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9
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Sampimon DE, Kolesnyk I, Korte MR, Fieren MWJA, Struijk DG, Krediet RT. Use of angiotensin II inhibitors in patients that develop encapsulating peritoneal sclerosis. Perit Dial Int 2011; 30:656-9. [PMID: 21148060 DOI: 10.3747/pdi.2009.00201] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Denise E Sampimon
- Division of Nephrology Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands.
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10
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Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD), but carries significant morbidity and mortality. We review the clinical features and radiologic and histologic changes found at diagnosis of EPS. Although EPS is strongly associated with the duration of PD, the pathogenesis remains only partly understood. We discuss the mechanisms thought to underlie the abnormally thickened, sclerotic peritoneal membrane seen in long-term PD patients including epithelial to mesenchymal transition and the molecular mediators of fibrosis and angiogenesis. We review how exposure to high-glucose, nonphysiological dialysis fluids, peritonitis, and uremia may be responsible for these changes. Much remains to be learned about optimal management of EPS, both medical and surgical, because the literature lacks controlled studies. Future research challenges include defining the role of surgery, immunosuppression, and antifibrotic agents in the management of EPS. We also need to understand why some patients progress from asymptomatic peritoneal sclerosis to the extreme levels of fibrin deposition and bowel encapsulation seen in EPS. Screening PD patients for potential future EPS remains difficult, and we need strategies for monitoring patients on longer-term PD that enable us to better quantify the risk of EPS for the individual patient.
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Affiliation(s)
- Catriona Goodlad
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.
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11
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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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12
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No need for an "expiry date" in chronic peritoneal dialysis to prevent encapsulating peritoneal sclerosis. Int Urol Nephrol 2010; 41:903-7. [PMID: 19856126 DOI: 10.1007/s11255-009-9661-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Liu L, Shi CX, Ghayur A, Zhang C, Su JY, Hoff CM, Margetts PJ. Prolonged Peritoneal Gene Expression Using a Helper-Dependent Adenovirus. Perit Dial Int 2009. [DOI: 10.1177/089686080902900507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis. The causes of EPS are not well defined and are likely multifactorial. A suitable animal model would facilitate research into the pathophysiology and treatment of EPS. Methods We developed a helper-dependent adenovirus that expresses both green fluorescent protein (GFP) and active transforming growth factor-beta (TGF-β1; HDAdTGF-β1). Mice were administered HDAdTGF-β1 via intraperitoneal injection and the response was compared with mice administered either first-generation adenovirus expressing TGF-β1 (AdTGF-β1) or control adenovirus (AdGFP). Results HDAdTGF-β1-treated mice continued to express the GFP reporter transgene to day 74, the end of the observation period. Transgene expression lasted less than 28 days in the animals treated with first-generation adenoviruses. Animals treated with first-generation AdTGF-β1 demonstrated submesothelial thickening and angiogenesis at day 7, with almost complete resolution by day 28. The HDAdTGF-β1-treated mice demonstrated progressive peritoneal fibrosis with adhesion formation and encapsulation of bowels. Weight gain was significantly reduced in animals treated with HDAdTGF-β1 compared to both the control-treated animals and the AdTGF-β1-treated animals. Inflammation was not a major component of the fibroproliferative response. Conclusions Peritoneal administration of a first-generation AdTGF-β1 leads to transient gene expression, resulting in a resolving fibrotic response and histology similar to that seen in simple peritoneal sclerosis. Prolonged TGF-β1 expression induced by the helper-dependent HDAdTGF-β1 led to changes in peritoneal morphology resembling EPS. This suggests that TGF-β1 may be a contributing factor in both simple peritoneal sclerosis and EPS. This model will be useful for elucidation of the mechanism of EPS and evaluation of potential treatment.
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Affiliation(s)
- Limin Liu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chang-Xin Shi
- Division of Hematology and Oncology, Comprehensive Cancer Center, Mayo Clinic, Scottsdale, Arizona
| | - Ayesha Ghayur
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Claire Zhang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Je Yen Su
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Catherine M. Hoff
- Renal Division, Scientific Affairs, Baxter Healthcare, McGaw Park, Illinois, USA
| | - Peter J. Margetts
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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de Freitas D, Augustine T, Hurst H, Taylor P, Williams R, Hutchison A, Brenchley PEC, Summers AM. Encapsulating peritoneal sclerosis following renal transplantation despite tamoxifen and immunosuppressive therapy. Clin Kidney J 2008; 1:333-5. [PMID: 25983927 PMCID: PMC4421261 DOI: 10.1093/ndtplus/sfn109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 07/14/2008] [Indexed: 11/14/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare disease in patients who have undergone peritoneal dialysis (PD). We report a case of EPS following renal transplantation that highlights important clinical issues. Initially, a presumptive diagnosis of EPS was made following surgical and pathological findings at the time of cholecystectomy. CT imaging at this time did not confirm the diagnosis. The patient continued PD and commenced tamoxifen. Prior to and immediately following transplantation, further CT imaging demonstrated no evidence of EPS. Acute bowel obstruction occurred 5 months post-transplantation and a diagnosis of EPS was made both clinically and on CT imaging, despite immunosuppression and tamoxifen. The role of these therapies in managing EPS post-transplant is discussed, in addition to the need for a high index of clinical suspicion to make the diagnosis.
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Affiliation(s)
- Declan de Freitas
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Titus Augustine
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Helen Hurst
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Paul Taylor
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Rosalind Williams
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Alastair Hutchison
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Paul E C Brenchley
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
| | - Angela M Summers
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester , UK
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16
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Schmidt DW, Flessner MF. Pathogenesis and Treatment of Encapsulating Peritoneal Sclerosis: Basic and Translational Research. Perit Dial Int 2008. [DOI: 10.1177/089686080802805s03] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Encapsulating peritoneal sclerosis is a devastating condition in long-term peritoneal dialysis patients. Animal models have employed chemical insults to simulate its pathology and have provided insights into its pathophysiology, which appears to include inflammation, angiogenesis, and fibrosis. Monitoring of biomarkers and interruption of molecular pathways have provided potential interventions to slow or prevent the disease process. However, there remain many questions concerning the trigger that alters chronic peritoneal inflammation in peritoneal dialysis to severe sclerosis, peritoneal adhesions, and bowel obstruction. Further advances in therapy will likely require an effective means of an early diagnosis through related biomarkers, which in turn will require further advances in the understanding of the pathogenesis of this disease process.
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Affiliation(s)
- Darren W. Schmidt
- Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael F. Flessner
- Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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Summers AM, Hoff CM, Topley N. How Can Genetic Advances Impact on Experimental Models of Encapsulating Peritoneal Sclerosis? Perit Dial Int 2008. [DOI: 10.1177/089686080802805s04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this review we discuss how animal models have contributed to the understanding of pathological pathways that may be involved in the development of encapsulating peritoneal sclerosis. We review the various interventional procedures that, so far, have ameliorated disease progression in animals. Reviewing advancements in molecular biology and genetic technologies, we discuss how future experimental models may impact our understanding of the pathogenesis and treatment of this rare but complex disease.
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Affiliation(s)
| | | | - Nicholas Topley
- School of Medicine, Cardiff University, Wales, United Kingdom
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