Division of Nephrology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Kidney Int. 2010 Jul;78(1):23-8. doi: 10.1038/ki.2010.90. Epub 2010 Mar 24.
Morphological changes of the peritoneal membrane that occur over time among patients on peritoneal dialysis include fibrosis and neoangiogenesis. While the pathophysiologic mechanisms underlying these changes are not fully understood, the activation of the renin-angiotensin-aldosterone system (RAAS) may have an important role. Components of the RAAS are constitutively expressed within peritoneal mesothelial cells, and are upregulated in the presence of acute inflammation and chronic exposure to peritoneal dialysate. The high glucose concentration, low pH, and the presence of glucose degradation products in peritoneal dialysis solutions have all been implicated in modulation of peritoneal RAAS. Furthermore, activation of the RAAS, as well as the downstream production of transforming growth factor-beta, contributes to epithelial-to-mesenchymal transformation of mesothelial cells, resulting in progressive fibrosis of the peritoneal membrane. This process also leads to increased vascular endothelial growth factor production, which promotes peritoneal neoangiogenesis. Functionally, these changes translate into reduced ultrafiltration capacity of the peritoneal membrane, which is an important cause of technique failure among patients on long-term peritoneal dialysis. This brief review will describe our current state of knowledge about the role of peritoneal RAAS in peritoneal membrane damage and potential strategies to protect the membrane.
腹膜透析患者腹膜的形态学变化包括纤维化和新生血管形成。虽然这些变化的病理生理机制尚未完全阐明，但肾素-血管紧张素-醛固酮系统（RAAS）的激活可能具有重要作用。RAAS 的成分在腹膜间皮细胞中持续表达，并在急性炎症和慢性暴露于腹膜透析液时上调。高葡萄糖浓度、低 pH 值以及腹膜透析液中葡萄糖降解产物的存在都与腹膜 RAAS 的调节有关。此外，RAAS 的激活以及下游转化生长因子-β的产生导致间皮细胞的上皮-间充质转化，导致腹膜的进行性纤维化。这个过程还导致血管内皮生长因子的产生增加，从而促进腹膜新生血管形成。从功能上讲，这些变化导致腹膜超滤能力下降，这是长期腹膜透析患者技术失败的一个重要原因。这篇简要综述将描述我们目前对腹膜 RAAS 在腹膜损伤中的作用以及保护腹膜的潜在策略的认识。
