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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 73 No. 3, 2019.

Review article

ENCAPSULATING PERITONEAL SCLEROSIS – THE ROLE OF COMPLEMENT

BOŽIDAR VUJIČIĆ orcid id orcid.org/0000-0001-6536-4786 ; Rijeka University Hospital Centre, Department of Internal Medicine, Division of Nephrology, Dialysis and Kidney Transplantation, Rijeka, Croatia
SANJIN RAČKI ; Rijeka University Hospital Centre, Department of Internal Medicine, Division of Nephrology, Dialysis and Kidney Transplantation, Rijeka, Croatia

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Abstract

Peritoneal dialysis (PD) is the most widely used home dialysis technique and is as effective as hemodialysis for the treatment of end-stage renal disease. The peritoneum in the abdominal cavity of the patients acts as a semi-permeable membrane allowing diffusion between the dialysis fl uid and the circulation. More biocompatible solutions are now being used that contain less glucose degradation products, which results in reduced peritoneal damage. The link between the complement system and PD seems less obvious because there is no direct contact with blood. However, mesothelial cells produce and secrete different complement factors including C4, C3, and C5 to C9. Cellular debris as a result of direct peritoneal damage by bioincompatible PD fl uids, as well as antibodies against microorganisms could contribute to local complement activation during PD. Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of insidious onset, presenting late as chronic malnourishment with signs and symptoms of intermittent, acute or subacute gastrointestinal obstruction. Ultrasonography, water-soluble contrast studies and computed tomography scanning are the most widely used radiological tests to aid the diagnosis of EPS. Results on complement inhibition in PD look promising, but many hurdles remain to be solved. Infection, fi brosis, and cardiovascular events are linked to the complement system. These results indicate the possibility of complement interventions in dialysis to improve biocompatibility, dialysis effi cacy, and long-term outcome.

Keywords

biocompatible solutions; complement; encapsulating peritoneal sclerosis; peritoneal dialysis; peritonitis

Hrčak ID:

229943

URI

https://hrcak.srce.hr/229943

Publication date:

5.12.2019.

Article data in other languages: croatian

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