FACTA UNIVERSITATIS

Vol.7, No 1, 2000 pp. 97 -101
UC 616.38

PERITONEAL LINING CELL CHANGES IN END STAGE KIDNEY DISEASE
Biljana Stojimirović ¹, Mirjana Obradović ³, Dušan Trpinac ³, Drago Milutinović ², Vidosava Nešić ¹
¹Institute of Nephrology and ²Urology, Clinical Center of Serbia, ³Institute of Histology, School of Medicine, University of Belgrade, Yugoslavia

Summary. Certain changes, known as uremic serositis, appear in morphology of serous membranes in end stage kid-ney disease (ESKD). They have been recognized on the pleura and pericardium for a long time. But uremic serositis affects, as it has been found in recent years, the peritoneum as well.
The aim of our investigation was to examine morphology of peritoneal lining cells in ESKD patients prior to the be-ginning of peritoneal dialysis (PD), to compare it with normal morphology of these structures and to point out the possible advantages of semi-thin sections of samples embedded in Epon resin stained with Toluidin Blue (TB) in com-parison with Hematoxylin-Eosin (HE) stained sections of samples embedded in Paraplast.
Biopsies of the peritoneum in 12 ESKD patients were taken during the catheter implantation prior to the first PD, so the changes of the peritoneal lining cells result from the pathophysiology of uremia. Biopsies of the peritoneum in 10 healthy volunteers were taken during the kidney donation. The samples were prepared in the standard way for study-ing on the light microscopy (LM) and transmission electron microscopy (TEM) levels.
One layer mesothelium of the cuboidal or flattened lining cells of healthy subjects showed some more subtle structural features using the semi-thin TB stained sections. In uremic patients, routine LM examination of HE stained sections evidenced epithelial stratification differentiating them from peritoneum of healthy persons. Unusual bulging of the mesothelial apical surface, deformation of mesothelial cells and their detachment from the basement membrane were observed using semi-thin TB stained sections analyzed by LM. Intracytoplasmic inclusions were visible only under TEM.
Our findings comply with reports of other authors. It should be stressed that EM examination is necessary only for detecting intracytoplasmic mesothelial cell inclusions and other characteristic ultrastructural changes in uremic sero-sitis. Some characteristic changes of peritoneal morphology mentioned above could be identified by LM of TB
stained semi-thin sections. This is of particular importance in those institutions which are not equipped with modern technology.
Key words: Mesothelium, uremia, peritoneal biopsy, peritoneal dialysis.

MORFOLOŠKE PROMENE ĆELIJA KOJE OBLAŽU PERITONEUM U TERMINALNOJ HRONIČNOJ BUBREŽNOJ BOLESTI

Kratak sadržaj: Promene, poznate kao uremijski serozitis, pojavljuju se na seroznim membranama u terminalnoj insuficijenciji bubrega. Za njih se već duže vreme zna na pleuri i perikardu. Poslednjih godina pokazano je da uremijski serozitis zahvata i peritoneum.
Cilj našeg istraživanja bio je da ispita morfologiju ćelija peritoneuma kod uremičnih bolesnika neposredno pre započinjanja peritoneumske dijalize (PD), da je uporedi sa normalnom morfologijom ovih struktura i da podvuče moguće prednosti metoda kalupljenja u Eponu i korišćenja polu tankih isečaka bojenih Toluidinom (TB), u odnosu na rutinski metod kalupljenja u Paraplastu i bojenja Hematoksilinom i Eozinom (HE).
Biopsije peritoneuma 12 uremičnih bolesnika uzete su tokom plasiranja katetera pre prve PD, pa su promene epitela peritoneuma posledica patofiziologije uremije. Biopsije peritoneuma 10 zdravih osoba uzete su tokom davanja bubrega. Uzorci su standardno pripremljeni za posmatranje svetlosnim mikroskopom (LM) i transmisionim elektronskim mikroskopom (TEM).
Kod zdravih osoba, jednoslojni mezotelijum sa kockastim i ljuspastim ćelijama, pokazao je nešto suptilnije strukturne odlike na polutankim isečcima bojenim Toluidinom. Kod uremičnih bolesnika, rutinska LM ispitivanja isečaka bojenih HE, za razliku od zdravih, pokazala su stratifikaciju epitela. Kod ovih bolesnika, neuobičajena ispupčenja mezotelne apikalne površine, deformacija mezotelnih ćelija i njihovo odlubljivanje od bazalne membrane uočeni su upotrebom LM i polutankih isečaka bojenih TB. Intracitoplazmatske inkluzije vidjene su samo korišćenjem TEM.
Naši rezultati saglasni su sa nalazima drugih autora. Treba naglasiti da je TEM potrebna samo za otkrivanje intracitoplazmatskih inkluzija i drugih ultrastrukturnih promena u mezotelnim ćelijama. Neke karakteristične promene morfologije peritoneuma, pomenute ranije, mogu se uočiti i upotrebom LM i proučavanjem TB obojenih polutankih isečaka. To je naročito važno u onim institucijama koje nisu opremljene modernom tehnologijom.
Ključne reči: Mezotel, uremija, biopsija peritoneuma, peritoneumska dijaliza