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Peritoneal Dialysis International :... 2016♦
UNLABELLED
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BACKGROUND
Preservation of the peritoneum is required for long-term peritoneal dialysis (PD). We investigated the effect of multiple peritonitis episodes on peritoneal transport. ♦
METHODS
Prospectively collected data from 479 incident PD patients treated between 1990 and 2010 were analyzed, using strict inclusion criteria: follow-up of at least 3 years with the availability of a Standard Peritoneal Permeability Analysis (SPA) in the first year after start of PD and within the third year of PD, without peritonitis preceding the first SPA. For the purpose of the study, we only included patients who remained peritonitis-free (n = 28) or who experienced 3 or more peritonitis episodes (n = 16). ♦
RESULTS
At baseline the groups were similar with regard to small solute and fluid transport. However, the frequent peritonitis group had lower peritoneal protein clearances compared to the no peritonitis group, resulting in lower dialysate concentrations of proteins: albumin 196.5 mg/L vs 372.5 mg/L, IgG 36.4 mg/L vs 65.0 mg/L, and α-2-macroglobulin (A2M) 1.9 mg/L vs 3.6 mg/L, p <0.01. No differences in serum concentrations were present. A comparison between the transport slopes over time in both groups showed a positive time trend of mass transfer area coefficient (MTAC) creatinine (p = 0.03) and glucose absorption (p = 0.09) and a negative trend of transcapillary ultrafiltration (p = 0.06), when compared to the no peritonitis group. Frequent peritonitis did not affect free water transport. ♦
CONCLUSIONS
Slow initial peritoneal transport rates of serum proteins result in lower dialysate concentrations, and likely a lower opsonic activity, which is a risk factor for peritonitis. Patients with frequent peritonitis show an increase in small solute transport and a concomitant decrease of ultrafiltration. In long-term peritonitis-free PD patients, small solute transport decreased, while ultrafiltration increased. This suggests that frequent peritonitis leads to an increase of the vascular peritoneal surface area without all the structural membrane alterations that may develop after long-term PD.
Topics: Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis; Prospective Studies
PubMed: 25395498
DOI: 10.3747/pdi.2014.00115 -
The Pan African Medical Journal 2022Pseudotumoral peritoneal tuberculosis is uncommon, but its incidence is high in endemic areas. Given the great radioclinical similarity between pseudotumoral peritoneal...
Pseudotumoral peritoneal tuberculosis is uncommon, but its incidence is high in endemic areas. Given the great radioclinical similarity between pseudotumoral peritoneal tuberculosis and ovarian cancer, we conducted a retrospective study in the Department of Obstetrics and Gynaecology of the Military Hospital of Instruction Mohammed V in Rabat, involving 14 cases (n= 14) of pseudotumoral peritoneal tuberculosis in order to illustrate the problem of differential diagnosis. All other extra-pelvic locations were excluded, the average age of our patients was 33.4 years with a maximum of cases in the 16-40 years group: 71% (n=10/14). Common clinical symptoms of this particular form of peritoneal tuberculosis were abdominal pain: 100% (n=14/14) associated with abdominopelvic mass: 71% (n=10/14) and ascites: 64% (n=09/14) mimicking peritoneal carcinosis of ovarian origin, especially since both pathologies progressed in a context of impaired general condition. Diagnosis was based on invasive laparoscopic examinations: 35% (n=05/14) or laparotomy: 57% (n=08/14) with biopsies. Indeed, only histological examination can help to establish definitive Corriger diagnosis, in the majority of cases. Therapeutic management of our patients was based on medical treatment, according to the national tuberculosis control program, and surgical treatment. The use of invasive explorations is often unavoidable before initiating any anti-bacillary treatment. Patients´ outcome under specific treatment is favorable, the prognosis of fertility is engaged in young women.
Topics: Humans; Female; Adult; Retrospective Studies; Peritonitis, Tuberculous; Peritoneum; Ascites; Laparoscopy; Diagnosis, Differential
PubMed: 36762164
DOI: 10.11604/pamj.2022.43.130.35899 -
Renal Failure Nov 2020Peritoneal dialysis (PD) is an important renal replacement therapy for end-stage renal disease (ESRD) patients. However, its complications, such as peritoneal fibrosis...
Peritoneal dialysis (PD) is an important renal replacement therapy for end-stage renal disease (ESRD) patients. However, its complications, such as peritoneal fibrosis (PF) and angiogenesis can cause ultrafiltration failure and PD termination. Histone deacetylase 6 (HDAC6) has been demonstrated to be involved in PF. However, its underlying role in peritoneal angiogenesis is still unknown and clinical value needs to be explored. In this study, we analyzed the expression of HDAC6 in the peritoneum from patients with non-PD and PD-related peritonitis and dialysis effluent from stable PD patients. Our study revealed that HDAC6 expressed highly in the peritoneum with peritonitis and co-stained with α-smooth muscle actin (α-SMA), a biomarker of the myofibroblast. And the level of HDAC6 in the dialysate increased with time and positively correlated with transforming growth factor-β1 (TGF-β1), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF), and negatively with cancer antigen 125 (CA125). , blockading HDAC6 with a selective inhibitor tubastatin A (TA) or silencing HDAC6 with a small interfering RNA (siRNA) prominently decreased IL-6-stimulated VEGF expression in cultured human peritoneal mesothelial cells (HPMCs), and inhibited proliferation and vasoformation of human umbilical vein endothelial cells (HUVECs). TA or HDAC6 siRNA also suppressed the expression of Wnt1, β-catenin, and the phosphorylation of STAT3 in IL-6-treated HPMCs. In summary, HDAC6 inhibition protects against PD-induced angiogenesis through suppression of IL-6/STAT3 and Wnt1/β-catenin signaling pathway, subsequently reducing the VEGF production and angiogenesis. It could become a new therapeutic target or forecast biomarker for PF, inflammation, and angiogenesis in the future.
Topics: Actins; Aged; Female; Histone Deacetylase 6; Histone Deacetylase Inhibitors; Humans; Hydroxamic Acids; Indoles; Interleukin-6; Male; Middle Aged; Neovascularization, Pathologic; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Peritonitis; RNA, Small Interfering; STAT3 Transcription Factor; Signal Transduction; Transforming Growth Factor beta1; Vascular Endothelial Growth Factor A; beta Catenin
PubMed: 32862739
DOI: 10.1080/0886022X.2020.1811119 -
The Journal of Clinical Investigation Nov 2019Essentially all Staphylococcus aureus (S. aureus) bacteria that gain access to the circulation are plucked out of the bloodstream by the intravascular macrophages of the...
Essentially all Staphylococcus aureus (S. aureus) bacteria that gain access to the circulation are plucked out of the bloodstream by the intravascular macrophages of the liver - the Kupffer cells. It is also thought that these bacteria are disseminated via the bloodstream to other organs. Our data show that S. aureus inside Kupffer cells grew and escaped across the mesothelium into the peritoneal cavity and immediately infected GATA-binding factor 6-positive (GATA6+) peritoneal cavity macrophages. These macrophages provided a haven for S. aureus, thereby delaying the neutrophilic response in the peritoneum by 48 hours and allowing dissemination to various peritoneal and retroperitoneal organs including the kidneys. In mice deficient in GATA6+ peritoneal macrophages, neutrophils infiltrated more robustly and reduced S. aureus dissemination. Antibiotics administered i.v. did not prevent dissemination into the peritoneum or to the kidneys, whereas peritoneal administration of vancomycin (particularly liposomal vancomycin with optimized intracellular penetrance capacity) reduced kidney infection and mortality, even when administered 24 hours after infection. These data indicate that GATA6+ macrophages within the peritoneal cavity are a conduit of dissemination for i.v. S. aureus, and changing the route of antibiotic delivery could provide a more effective treatment for patients with peritonitis-associated bacterial sepsis.
Topics: Animals; Female; GATA6 Transcription Factor; Macrophages, Peritoneal; Male; Mice; Peritonitis; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Vancomycin
PubMed: 31545300
DOI: 10.1172/JCI127286 -
Kidney International Apr 2011For patients on peritoneal dialysis (PD), the development of peritonitis, the decline of residual kidney function, and the loss of peritoneal membrane function are... (Review)
Review
For patients on peritoneal dialysis (PD), the development of peritonitis, the decline of residual kidney function, and the loss of peritoneal membrane function are central events that affect both patient and technique survival. The use of glucose as the osmotic agent in conventional PD solutions may increase the susceptibility to each of these events. However, its use may also be associated with systemic metabolic perturbations and, in turn, an increase in cardiovascular morbidity. Both in vitro and in vivo evidence suggest that both the local peritoneal and systemic toxicity induced by the use of glucose may be in part mediated by the presence of glucose degradation products (GDPs) coupled with the hyperosmolarity, reduced pH, and use of lactate as the buffer in conventional PD solutions. Therefore, the use of neutral pH, low-GDP (NpHL(GDP)), bicarbonate-buffered PD solutions may represent a promising strategy to attenuate some of these adverse effects. However, the impact of these novel solutions on clinical outcomes remains largely unknown. In this review, we will highlight evidence regarding the biocompatibility of NpHL(GDP) PD solutions, review the utility of current biomarkers in the evaluation of biocompatibility, and discuss the clinical outcome data with these solutions.
Topics: Biocompatible Materials; Biomarkers; CA-125 Antigen; Dialysis Solutions; Glucose; Glycation End Products, Advanced; Humans; Hydrogen-Ion Concentration; Interleukin-6; Kidney; Lactic Acid; Peritoneal Dialysis; Peritoneum; Peritonitis; Vascular Endothelial Growth Factor A
PubMed: 21248712
DOI: 10.1038/ki.2010.515 -
European Review For Medical and... Feb 2023We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet...
OBJECTIVE
We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB).
PATIENTS AND METHODS
Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered.
RESULTS
Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures. However, seven were converted to open laparotomy.
CONCLUSIONS
Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.
Topics: Humans; Ascites; Retrospective Studies; Peritonitis, Tuberculous; Peritoneum; Laparoscopy
PubMed: 36808343
DOI: 10.26355/eurrev_202302_31192 -
ELife Feb 2019Bacterial spillage into a sterile environment following intestinal hollow-organ perforation leads to peritonitis and fulminant sepsis. Outcome of sepsis critically...
Bacterial spillage into a sterile environment following intestinal hollow-organ perforation leads to peritonitis and fulminant sepsis. Outcome of sepsis critically depends on macrophage activation by extracellular ATP-release and associated autocrine signalling via purinergic receptors. ATP-release mechanisms, however, are poorly understood. Here, we show that TLR-2 and -4 agonists trigger ATP-release via Connexin-43 hemichannels in macrophages leading to poor sepsis survival. In humans, Connexin-43 was upregulated on macrophages isolated from the peritoneal cavity in patients with peritonitis but not in healthy controls. Using a murine peritonitis/sepsis model, we identified increased Connexin-43 expression in peritoneal and hepatic macrophages. Conditional mice were developed to specifically assess Connexin-43 impact in macrophages. Both macrophage-specific Connexin-43 deletion and pharmacological Connexin-43 blockade were associated with reduced cytokine secretion by macrophages in response to LPS and CLP, ultimately resulting in increased survival. In conclusion, inhibition of autocrine Connexin-43-dependent ATP signalling on macrophages improves sepsis outcome.
Topics: Adenosine Triphosphate; Animals; Autocrine Communication; Connexin 43; Disease Models, Animal; Gene Expression Regulation; HEK293 Cells; Humans; Lipopolysaccharides; Liver; Macrophage Activation; Macrophages; Mice; Peritoneal Cavity; Peritonitis; Probenecid; Sepsis; Toll-Like Receptor 2; Toll-Like Receptor 4
PubMed: 30735126
DOI: 10.7554/eLife.42670 -
BMC Infectious Diseases Aug 2014The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.
METHODS
A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.
RESULTS
A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.
CONCLUSION
We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol.
Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Therapy, Combination; Humans; Peritoneal Dialysis; Peritonitis
PubMed: 25135487
DOI: 10.1186/1471-2334-14-445 -
Gut Aug 1972Enterobius vermicularis (the pinworm) commonly infests the lumen of the intestine but on rare occasions has been found in the wall or in the tissues outside the...
Enterobius vermicularis (the pinworm) commonly infests the lumen of the intestine but on rare occasions has been found in the wall or in the tissues outside the gastrointestinal tract. Three such patients have been encountered in whom Enterobius vermicularis was found in the wall of the colon, in the retrocaecal tissues, and on the peritoneum. The pathological lesions and their relationship to the clinical features are discussed. A brief review of the literature is given. It is concluded that Enterobius vermicularis can only penetrate the wall of the gastrointestinal tract if this is diseased. Once in the tissues the worms can cause an inflammatory reaction simulating carcinoma and Crohn's disease, and, by perforation of the intestine, cause a generalized peritonitis.
Topics: Cecal Diseases; Cecal Neoplasms; Cecum; Colon; Colonic Diseases; Crohn Disease; Diagnosis, Differential; Enterobius; Female; Humans; Intestinal Diseases; Male; Oxyuriasis; Peritoneal Diseases; Peritoneum; Peritonitis
PubMed: 5077172
DOI: 10.1136/gut.13.8.621 -
Scientific Reports Aug 2022Peritoneal dialysis (PD) patients are at high risk for peritonitis, an infection of the peritoneum that affects 13% of PD users annually. Relying on subjective...
Peritoneal dialysis (PD) patients are at high risk for peritonitis, an infection of the peritoneum that affects 13% of PD users annually. Relying on subjective peritonitis symptoms results in delayed treatment, leading to high hospitalisation costs, peritoneal scarring, and premature transition to haemodialysis. We have developed and tested a low-cost, easy-to-use technology that uses microscopy and image analysis to screen for peritonitis across the effluent drain tube. Compared to other technologies, our prototype is made from off-the-shelf, low-cost materials. It can be set up quickly and key stakeholders believe it can improve the overall PD experience. We demonstrate that our prototype classifies infection-indicating and healthy white blood cell levels in clinically collected patient effluent with 94% accuracy. Integration of our technology into PD setups as a screening tool for peritonitis would enable earlier physician notification, allowing for prompt diagnosis and treatment to prevent hospitalisations, reduce scarring, and increase PD longevity. Our findings demonstrate the versatility of microscopy and image analysis for infection screening and are a proof of principle for their future applications in health care.
Topics: Cicatrix; Humans; Microscopy; Peritoneal Dialysis; Peritoneum; Peritonitis
PubMed: 35982214
DOI: 10.1038/s41598-022-18380-9