La péritonite sclérosante et encapsulante
| Autor: | Clémence Béchade, Thierry Lobbedez, Maxence Ficheux, Bruno Hurault de Ligny, Nicolas Bouvier, Jean-Philippe Ryckelynck |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment 030232 urology & nephrology Inflammation medicine.disease Gastroenterology Pathophysiology Surgery Peritoneal dialysis 03 medical and health sciences 0302 clinical medicine Parenteral nutrition Nephrology Fibrosis Internal medicine medicine 030212 general & internal medicine Hemodialysis medicine.symptom business Complication Kidney transplantation |
| Zdroj: | Néphrologie & Thérapeutique. 13:211-219 |
| ISSN: | 1769-7255 |
| DOI: | 10.1016/j.nephro.2017.01.020 |
| Popis: | Encapsulating peritoneal sclerosis is a rare but devastating complication of long-term peritoneal dialysis with a high mortality rate. The incidence is between 0.5 and 2.5%, decreasing with time. PSE is defined as a clinical syndrome with signs of gastrointestinal obstruction, inflammation parameters, radiological and macroscopic changes. The duration of treatment and the cessation of peritoneal dialysis are the main risks. About 75% occured in patients on hemodialysis or after kidney transplantation. Morphological alterations are disappearance of mesothelial layer, submesothelial fibrosis, interstitial sclerosis and vasculopathy. Ultrafiltration failure, fast transport status of the peritoneal membrane and loss of sodium sieving, the most powerful predictor, are the functional abnormalities. Biomarkers in peritoneal effluent include cancer antigen 125, interleukin-6. The pathophysiology is probably a consequence of a multiple-hit process in which expression of growth factors and cytokines play a central role. Medical strategies (corticosteroids, tamoxifen) in association with parenteral nutrition and/or surgery (enterolysis) are discussed. Prevention is the use of physiological peritoneal dialysis solutions, icodextrine instead of high glucose concentration solutions and peritoneal lavage after peritoneal dialysis stopping. |
| Databáze: | OpenAIRE |
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