Albert Schweitzer Hospital, Department of Internal Medicine, PO Box 444, 3300 AK Dordrecht, The Netherlands.
Nat Rev Nephrol. 2011 Aug 2;7(9):528-38. doi: 10.1038/nrneph.2011.93.
Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD) with a 50% mortality rate. EPS is characterized by progressive and excessive fibrotic thickening of the peritoneum, leading to encapsulation of the bowels and intestinal obstruction. At present, EPS cannot be detected with certainty during its early stages; however, a progressive loss of ultrafiltration capacity often precedes its development. Studies that attempted to elucidate the pathogenesis of EPS have shown that the duration of exposure to PD fluids is the most important risk factor for EPS, and that young age and possibly the effects of peritonitis are additional contributory factors. The pathophysiology of EPS is probably best described as a multiple-hit process with a central role for transforming growth factor β. A form of EPS that develops shortly after kidney transplantation has also been recognized as a distinct clinical entity, and may be a common form of EPS in countries with a high transplantation rate. Criteria have been developed to identify EPS by abdominal CT scan at the symptomatic stage, but further clinical research is needed to identify early EPS in asymptomatic patients, to clarify additional risk factors for EPS and to define optimal treatment strategies.
包裹性腹膜硬化症（EPS）是长期腹膜透析（PD）的严重并发症，死亡率为 50%。EPS 的特征是腹膜进行性和过度纤维化增厚，导致肠道包裹和肠梗阻。目前，在早期阶段无法确定 EPS；然而，超滤能力的逐渐丧失往往先于其发展。试图阐明 EPS 发病机制的研究表明，PD 液暴露时间是 EPS 的最重要危险因素，而年轻和可能的腹膜炎影响是另外的促成因素。EPS 的病理生理学可能最好被描述为一个多打击过程，其中转化生长因子 β 起核心作用。在肾移植后不久发展的一种形式的 EPS 也被认为是一种独特的临床实体，并且可能是移植率高的国家的常见形式的 EPS。已经制定了通过腹部 CT 扫描在症状阶段识别 EPS 的标准，但需要进一步的临床研究来识别无症状患者的早期 EPS，以澄清 EPS 的其他危险因素并定义最佳治疗策略。
