高浓度葡萄糖对人腹膜间皮细胞生长和基质合成的影响

持续性不卧床腹膜透析（ＣＡＰＤ）时腹膜间皮层直接浸泡于含葡萄糖１．５０％～４．２５％的透析液中，为了探讨高浓度葡萄糖对腹膜间皮细胞生长和基质合成的影响，我们建立了人腹膜间皮细胞（ＨＭＣ）培养体系。ＨＭＣ在含葡萄糖浓度≥１．００％的培养基中生长时，￣３Ｈ－ＴｄＲ掺入量较在０．１０％或不加葡萄糖的培养基中生长时明显降低。当介质中葡萄糖浓度≥０．５０％时ＨＭＣ培养上清的纤维连接蛋白（ＦＮ）水平明显增高。葡萄糖引起的细胞增殖抑制和ＦＮ分泌增加均呈时间与剂量依赖关系。用甘露醇代替葡萄糖进行试验得到相似结果，但其抑制细胞增殖的作用明显弱于相同渗量的葡萄搪。上述结果表明，周围介质中高浓度的葡萄糖对ＨＭＣ生长和基质合成具有直接影响。反复或长期使用高糖透析液引起的ＨＭＣ修复和代谢障碍可能参与了ＣＡＰＤ相关性腹膜硬化的发生。     

连续性不卧床腹膜透析中类酵母菌性腹膜炎2例报告

连续性不卧床腹膜透析中类酵母菌性腹膜炎２例报告天津医科大学第二医院（３００２１１）施炜苏如松例１：男６８岁。慢性肾功能不全２年。１９９６年７月始行连续性不卧床腹膜透析（ＣＡＰＤ）治疗，１年后在家自行ＣＡＰＤ治疗期间出现发热、腹痛，透出液混浊，诊断为腹...     

腹膜透析病人的蛋白质摄人问题

腹膜透析病人的蛋白质摄人问题中山医科大学肾脏实验室（５１００８０）叶任高，江涛腹膜透析病人蛋白质营养不良的发生率较高，据统计，约１８％～５６％的持续性不卧床腹膜透析（ＣＡＰＤ）病人有蛋白质能量营养不良的表现，还有许多ＣＡＰＤ病人有亚临床状态的营养不良...     

腹膜透析能否优于血液透析？

腹膜透析能否优于血液透析？姚小丹刘红关键词腹膜透析血液透析透析效果中图法分类号Ｒ４５９．５自１９７６年，Ｐｏｐｏｖｉｃｈ和Ｍｏｎｃｒｉｅｆ首次在临床上应用连续不卧床腹膜透析（ＣＡＰＤ）方法治疗尿毒症以来，腹膜透析（ＰＤ）技术得到了迅猛发展及广泛临床应...     

腹膜平衡试验在腹膜透析临床应用的探讨

７０例８７次腹膜平衡试验（ＰＥＴ）中高转运（Ｈ）１９例，高于平均转运（ＨＡ）２６例，低于平均转运（ＬＡ）１９例，低转运（Ｌ）６例。１７次重复ＰＥＴ中９次无变化，９次调换透析液后４次ＬＡ者转为ＨＡ，２次ＨＡ者转为Ｈ，１次转为ＨＡ。１次有近期腹腔感染者ＨＡ转变成Ｈ。根据ＰＥＴ分别采用ＤＡＰＤ３４例，ＣＡＰＤ３６例。４例采用ＣＡＰＤ治疗的Ｈ患者中２例出现水潴留；４例ＬＡ及１例Ｌ患者采用ＤＡＰＤ治疗的有３例出现尿毒症症状，分别改为ＤＡＰＤ及ＣＡＰＤ治疗后症状缓解，其余４例有残余肾功能而未出现症状。３年内透析期及年龄对ＰＥＴ无显著影响     

腹膜透析患者的营养问题

腹膜透析患者的营养问题俞雨生关键词腹膜透析；机体代谢；营养随着腹膜透析装置的不断改善，透析合并感染的机会明显减少，而营养不良等合并症则日显突出。据统计，在连续不卧床腹膜透析（ＣＡＰＤ）的患者中，营养不良的发生率约占１７％～５６％，且随着腹膜透析（ＰＤ...     

儿童持续性腹膜透析

儿童持续性腹膜透析李立，唐政儿童持续腹膜透析（ＣＡＰＤ或ＣＣＰＤ）技术简单，便于操作，已成为患儿肾脏替代治疗的重要方法，它适用于婴幼儿及各年龄组的患儿。腹膜透析于６０年代首先用于治疗儿童急性肾衰，并很快在全世界得到推广应用；而用于儿童终末期肾衰（ＥＳ...     

腹膜透析存在的问题与未来展望

腹膜透析存在的问题与未来展望俞雨生综述关键词腹膜透析慢性肾衰透析液中图法分类号Ｒ４５９，５腹膜透析（ＰＤ）用于临床已有数十年历史，对改善慢性肾衰患者的临床症状及延长生命起了重要的作用。尽管如此，ＰＤ还有不少问题尚未解决，如对肾性贫血的治疗效果较差，不...     

终末期糖尿病肾病患者持续性非卧床腹膜透析与血液透…

目的：研究糖尿病终末期肾病（ＥＳＲＤ）患者的透析治疗，选择血液透析（ＨＤ）好还是持续性非卧床腹膜透析（ＣＡＰＤ）好。 方法：观察了８例接受透析治疗的糖尿病ＥＳＲＤ患者，其中５２例进行ＨＤ治疗，１６例进行ＣＡＰＤ治疗。对比两组患者透析前后的血液生化指标、生存率、死亡原因、血糖的控制、透析后主要并发症。 结果：６０岁以下ＨＤ或ＣＡＰＤ治疗患者３年生存率均达７５％以上。但透析前合并有高血压、心脏肥大、冠     

终末期多囊肾患者CAPD和血液透析充分性的比较

终末期多囊肾患者ＣＡＰＤ和血液透析充分性的比较谢春，潘达亮，叶任高，李惠群持续性不卧床腹膜透析（ＣＡＰＤ）治疗多囊肾所致的尿毒症效果如何，尚未见诸文献报道。本文旨在比较终末期多囊肾患者ＣＡＰＤ与血液透析（ＨＤ）的充分性。对象与方法２６例为１９８２～１...     

Dialysate leukocytes, sICAM-1, hyaluronan and IL-6: predictors of outcome of peritonitis?

BACKGROUND/AIMS: Despite effective antibiotic therapy, peritonitis still remains a major problem in peritoneal dialysis (PD). The aim of the present study was to investigate changes of CRP, dialysate leukocytes and IL-6, hyaluronan (HA) and sICAM-1 in dialysate during and after peritonitis and their association to the outcome of peritonitis. METHODS: Dialysate IL-6, HA and sICAM-1 were measured at the onset and on day 4, at the end of the treatment and 2 months after onset of peritonitis. Furthermore, CRP and dialysate leukocytes were measured on days 1-4. RESULTS: All measured soluble factors were higher on the first and fourth day than at the end of the treatment. sICAM-1 and HA were lower at the end of the treatment in patients who later had a relapse/re-infection. IL-6 remained higher 2 months after clinically cured peritonitis. CRP and dialysate leukocytes were higher on day 4 in patients with poor outcome. CONCLUSIONS: Peritonitis causes increased excretion of soluble factors. Low concentrations of sICAM-1 and HA at the end of the treatment were negative prognostic indicators. Higher IL-6 levels after peritonitis could be a sign of ongoing inflammation in the peritoneal membrane. Delayed decrease in CRP and dialysate leukocytes may indicate poor outcome.     

Efficacy of intravenous vancomycin in the treatment of gram-positive peritonitis in long-term peritoneal dialysis

Peritonitis is the major complication of long-term peritoneal dialysis. Gram-positive bacteria are responsible for two thirds of the total number of peritonitis episodes. Conventional therapy consists of daily administration of antibiotics, either parenterally or intraperitoneally. Vancomycin, an antibiotic with a prolonged half-life in renal failure, has a wide spectrum of activity against gram-positive bacteria and diffuses readily across the peritoneal membrane. In the present study, 82 percent of gram-positive peritonitis episodes were cured following the intravenous administration of vancomycin at weekly intervals. This cure rate compares favorably with that obtained following conventional therapy of peritonitis. It is concluded that intravenous vancomycin is an effective treatment for gram-positive peritonitis in patients undergoing long-term peritoneal dialysis. This form of therapy is convenient, reduces hospitalization, minimizes cost, and avoids possible contamination of the peritoneal dialysate used during the intraperitoneal administration of antibiotics.     

Intraperitoneal nitric oxide production in patients treated by continuous ambulatory peritonal dialysis

BACKGROUND: Nitric oxide (NO) generation within the peritoneum could potentially affect peritoneal transport by increasing capillary vasodilatation, and increase peritoneal permeability during episodes of bacterial peritonitis. As peritoneal mesothelial cells have a common embryological derivation with endothelial cells, then mesothelial cells could potentially be a major source of locally produced NO. METHODS: NO was measured using the Griess reaction in fresh and spent dialysate effluent (SPDE) from uninfected CAPD patients, and from those during episodes of bacterial peritonitis. Human peritoneal mesothelial cells (HPMC) were cultured and NO production determined in the presence of SPDE and the effect of a potential NO substrate, L-arginine, and NO synthase inhibitor, L-NMMA. NO production by peritoneal macrophages (M?), obtained from SPDE and the effect of staphylococci was also determined. RNA for inducible nitric oxide synthase (iNOS) was sought using Northern blotting technique following combination stimulation with lipopolysaccharide and cytokines (IL-1beta, TNF-alpha and gamma-INF, and/or spent dialysate from patients with bacterial peritonitis). RESULTS: Whereas fresh CAPD dialysate was nitrite-free, SPDE from the day time exchange contained 41 +/- 3 microM (nitrite and nitrate), and that from the overnight dwell 91 +/- 8 microM. During CAPD peritonitis, dialysate nitrite and nitrate increased from 9.3 +/-0.8 to 17.5 +/- 2.4 microM/l x h, for the first CAPD bag at presentation, and 15.2 +/- 1.8 for the second and 16.2 +/- 2.4 for the third exchange (p < 0.01 compared to non-infected control). By the second day, levels had returned to baseline, 7.3 +/- 0.9 microM/l x h. HPMC produced 261 nmol nitrate and nitrite/mg cell protein, and this increased in a dose-dependent manner with the addition of spent uninfected CAPD dialysate, to 365 nmol/mg with 1:10 dilution and 655 nmol/mg with 1:2 dilution, p < 0.001. The addition of the substrate, L-arginine, resulted in a 10% increase in nitrite and nitrate production, whereas the addition of L-NMMA produced a 10% reduction. Peritoneal M? obtained from SPDE produced similar quantities of nitrite and nitrate to peritoneal mesothelial cells, and cultures of Staphylococcus aureus resulted in a reduction in nitrite and nitrate levels, as they were used as a growth requirement. However, we could not demonstrate RNA production for iNOS by HPMC following cytokine or SPDE stimulation. CONCLUSIONS: This suggests that HPMC may be an important source of locally generated NO within the peritoneal cavity under basal conditions, but as they do not contain iNOS, the increased NO produced during episodes of acute bacterial peritonitis is more likely due to a combination of increased NO production by peritoneal endothelial cells and transmigrating macrophages.     

Sclerosing peritonitis: an unusual cause of ascites in a patient with systemic lupus erythematosus

Sclerosing peritonitis is a rare condition characterised by fibrosis and adhesion of the peritoneum to loops of the small intestine. It is generally associated with continuous peritoneal dialysis, peritoneo-venous shunts or &beta-adrenergic blocking agents. In this case we report a female patient with idiopathic sclerosing peritonitis and systemic lupus erythematosus.     

Peritonitis Due to Neisseria mucosa in an Adolescent Receiving Peritoneal Dialysis

Abstract Neisseria mucosa is part of the normal nasopharyngeal flora and rarely pathogenic in humans. Reports of serious infections associated with this pathogen are very unusual. A 17–year–old boy with end–stage renal disease due to IgA nephropathy presented with acute, spontaneous, symptomatic peritoneal dialysis–associated peritonitis without reported break in sterility or PD catheter exit site infection. β–lactamase–negative N. mucosa was isolated from the dialysate effluent. Intraperitoneal antibiotic treatment with cephalothin/gentamicin for 5 days and subsequent ceftriaxone led to complete resolution of the infection. This case demonstrates that "non–pathogenic" Neisseria species can cause clinically severe peritonitis with high intraperitoneal neutrophil counts, elevated C–reactive protein levels in the peritoneal effluent (in the presented case, 27,600/μl and 3.6 mg/l, respectively) and impaired peritoneal membrane transport function. To our knowledge, this is the first case of N. mucosa peritonitis complicating chronic peritoneal dialysis in an adolescent patient. This paper is dedicated to the founders of the Walter Marget Foundation, D. Adam and F. Daschner, in gratitude for their support of the training in infectious diseases.     

La péritonite encapsulante. A propos d’un cas

Or sclerosing encapsulating peritonitis is diffuse peritoneal fibrosis may develop into a true sclerosis, or a hull sheathing peritoneal intestinal loops commonly found in a cocoon during laparoscopy or laparotomy. His diagnosis but especially pre-operative enables the surgeon to treat the patient optimally. The main etiologies are peritoneal dialysis, intraperitoneal chemotherapy, infections. We report a case of peritonitis encapsulating and discuss its main clinical and etiopathogenic.     

Sclerosing peritonitis

The case presented in this study illustrates the peritoneal changes observed in long-term peritoneal dialysis (PD) patients. This male patient was on peritoneal dialysis (CAPD) for seven months before and 86 months after renal transplantation. Two episodes of peritonitis occurred during that time. The patient developed symptoms (ascites, gastro-intestinal disturbances, deteriorating general condition, inflammatory syndrome) four months after starting hemodialysis, one month after ablation of the PD catheter. Other potential causes (infection, malignancy, hepatitis, etc.) of these symptoms were ruled out following an exhaustive etiological work-up. A final diagnosis of sclerosing peritonitis was made, and the patient was started on corticosteroid therapy. Both morphological and functional alterations of the peritoneal membrane associated with long term PD and the detection of such alterations in everyday practice are reviewed here, along with possible etiological factors and therapeutic measures discussed in the literature. A better understanding of the pathophysiological mecHanisms underlying these alterations would make it possible to develop preventive measures, such as more biocompatible dialysates.     

Catheter design for continuous flow peritoneal dialysis.

A new catheter for continuous flow peritoneal dialysis is presented. One of the main issues in this field is the safety and good clinical tolerance of the catheter. In this case, the size and diameter of the cannula has not been increased in comparison to previous PD catheters. Furthermore, the materials utilized are designed for maximum comfort of the patient and minimal traumatisation of the peritoneal membrane. Nevertheless, the two compartments of the catheter allow for high dialysate flows without creating high resistance and the rate of recirculation is minimal in conditions of simulated continuous flow PD. Furthermore, the characteristic of the new catheter is the presence in the inflow branch of a special diffuser designed like a shower cap that is intended to improve the dialysate inflow distribution in the peritoneal cavity and to increase the contact of the peritoneal membrane with the solution. At the same time, the diffuser prevents a traumatic effect of the inflow dialysate due to high speed infusion or jet flow conditions.     

Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique

The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter‐related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter‐related complications and follow‐up data. Sixty‐nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long‐term survivals. All of the CAPD‐related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.     

Recurrent chronic ambulatory peritoneal dialysis-associated infection due to rothia dentocariosa.

Rothia dentocariosa is a commensal organism of the human oropharynx. Clinical infection due to this organism is rare. A case of recurrent peritoneal dialysis-related peritonitis caused by R dentocariosa and a review of the literature is reported. Isolation of R dentocariosa from dialysate fluid should not be dismissed as a contaminant. Although there are no interpretive criteria for antimicrobial susceptibility testing, R dentocariosa appears to be susceptible to a variety of antibiotics including beta-lactams, vancomycin and aminoglycosides. Optimal therapy of peritoneal dialysis peritonitis caused by this organism may also require removal of the catheter.