CIN '2007 - 4º CONGRESO DE NEFROLOGIA EN INTERNET
The Story of the Epithelial-to-Mesenchymal Transition and its pathogenic role in peritoneal dialysis
Dr Rafael Selgas
Hospital Universitario de La Paz. Madrid
Abstract
The expansion of peritoneal dialysis (PD) is currently limited by the membrane incapacity to perform appropriate solute and water transport at long-term (1,2,3,4,5,6,7). The functional consequence is ultrafiltration failure (UFF), that results in extracellular volume overload, increased cardiovascular risk, and restricts the technique continuity (8,9,10,11). Functional deterioration of the peritoneum has been related to the damage induced by PD fluids and peritonitis. Peritoneal cell biology and histopathology studies are helping us to understand the pathophysiology of the peritoneal membrane response (12,13,14,15,16,17,18). Human histopathology studies have been mostly based on long-term PD patients with peritoneal functional problems, specifically UFF (19,20). Advanced morpho-pathologic changes such as fibrosis, angiogenesis and vasculopathy could in consequence be overrepresented in these studies. It is our opinion that many of the functional and anatomical data available are based on data from very late peritoneal stages, in some sense, terminal stages. We admit that these lesions are the main cause of functional disorder after 3-8 years on PD (21,22,23). Unfortunately, therapy for this terminal situation is unsuccessful and a pessimistic point of view is the unavoidable consequence. We believe that it is time to pay greater attention to earlier stages of these lesions when therapeutic molecular interventions are still possible.Comentarios :