Pathophysiological Changes to the Peritoneal Membrane during PD-Related Peritonitis: The Role of Mesothelial Cells

[摘要] The success of peritoneal dialysis (PD) is dependent on the structural and functional integrity of theperitoneal membrane. The mesothelium lines the peritoneal membrane and is the first line ofdefense against chemical and/or bacterial insult. Peritonitis remains a major complication of PD andis a predominant cause of technique failure, morbidity and mortality amongst PD patients. Withappropriate antibiotic treatment, peritonitis resolves without further complications, but in some PDpatients excessive peritoneal inflammatory responses lead to mesothelial cell exfoliation andthickening of the submesothelium, resulting in peritoneal fibrosis and sclerosis. The detrimentalchanges in the peritoneal membrane structure and function correlate with the number and severityof peritonitis episodes and the need for catheter removal. There is evidence that despite clinicalresolution of peritonitis, increased levels of inflammatory and fibrotic mediators may persist in theperitoneal cavity, signifying persistent injury to the mesothelial cells. This review will describe thestructural and functional changes that occur in the peritoneal membrane during peritonitis and howmesothelial cells contribute to these changes and respond to infection. The latter part of the reviewdiscusses the potential of mesothelial cell transplantation and genetic manipulation in thepreservation of the peritoneal membrane.

[学科分类] 生理学与病理学