del Peso G, Jiménez-Hefferman J A, Bajo M A, Sánchez-Villanueva R, Tabernero A, Aroeira L, Selgas R
Servicio de Nefrología. Hospital Universitario La PazPaseo de la Castellana, 26128046 Madrid, España.
Nefrologia. 2008;28 Suppl 6:11-6.
Ultrafiltration failure is the most frequent alteration of peritoneal transport in peritoneal dialysis (PD) patients, and is a frequent cause of technical withdrawal. At the beginning of the therapy, there is a great functional diversity, but alter the third or fourth years the 20% of patients develop progressive ultrafiltration failure and an increase of the small solute transport. In parallel to this functional alteration, the peritoneum of PD patients shows morphological alterations, such as loss or transformation of mesothelial cells, basal membrane reduplication, submesothelial fibrosis, hyalinazing vasculopathy and neoangiogenesis. There are scant comparative studies of morphofunctional correlation. Most of them have been reported on long-term PD patients and showed a progressive increase of fibrosis and vasculopathy with time on PD, specially in patients with ultrafiltration failure and in those with sclerosing peritonitis. The peritoneal vessel number do not always increase with time on PD, and it is associated with advanced ultrafiltration failure. Some short-term studies have demonstrated that the initial lesion related to the high small solute peritoneal transport is the epithelial to mesenchimal transition of the mesothelial cell (the transformation of mesothelial cell into fibroblastic cell). The higher secretion of extracellular matrix and vascular endothelial growth factor by the transformed mesothelial cells should participated on later development of fibrosis and high peritoneal permeability, not always in relation with higher number of peritoneal vessels.
超滤失败是腹膜透析（PD）患者最常见的腹膜转运改变，也是技术退出的常见原因。在治疗开始时，存在很大的功能差异，但在治疗的第三或第四年，20%的患者会出现进行性超滤失败和小分子溶质转运增加。与这种功能改变同时，PD患者的腹膜显示出形态学改变，如间皮细胞的丢失或转化、基底膜重复、间皮下纤维化、玻璃样变血管病和新生血管形成。关于形态功能相关性的比较研究很少。大多数研究报道的是长期PD患者，显示随着PD时间的延长，纤维化和血管病逐渐增加，特别是在超滤失败的患者和硬化性腹膜炎患者中。腹膜血管数量并不总是随着PD时间的延长而增加，并且与晚期超滤失败有关。一些短期研究表明，与小分子溶质高腹膜转运相关的初始病变是间皮细胞的上皮-间充质转化（间皮细胞转化为成纤维细胞）。转化的间皮细胞分泌的细胞外基质和血管内皮生长因子增加，应该参与了纤维化和高腹膜通透性的后期发展，并不总是与腹膜血管数量增加有关。
