2018 Volume 51 Issue 1 Pages 77-86
Prolonged peritoneal dialysis (PD) causes progressive morphological changes (i.e., the deterioration of the peritoneal membrane), leading to an increased risk of encapsulating peritoneal sclerosis (EPS). Histological assessments of peritoneal membrane biopsy samples are required to evaluate the peritoneal damage caused by PD. To evaluate the serial morphological changes induced in the peritoneum by PD, peritoneal biopsy examinations should be performed not only after the cessation of PD, but also before performing PD. During PD catheter insertion, the parietal peritoneum (1.5×1.5 cm) and the posterior sheath of the rectus abdominal muscle should be sampled at 3 cm below the PD catheter insertion site. Also, during PD catheter removal the parietal peritoneum should be sampled at 3 cm from the PD catheter insertion site. The peritoneum should be examined for mesothelial cell denudation, acellular sclerotic changes, vasculopathy, vascular angiogenesis, and new encapsulating membranes, and the thickness of the submesothelial connective tissue should also be assessed. The method presented herein allows artifacts to be minimized and peritoneal biopsy examinations to be performed safely. Morphological evaluations of the peritoneum involving an appropriate biopsy strategy, as well as functional markers of deterioration, such as peritoneal permeability or cytokine levels, is a useful means of examining peritoneal damage and predicting the onset of EPS.
