Fibrosis and sclerosis: different disorders or different stages?

Area of Science:

• Nephrology
• Pathology
• Gastroenterology

Background:

• Peritoneal sclerosis is a frequent complication in patients undergoing peritoneal dialysis (PD).
• Manifestations range from mild, asymptomatic changes to severe, fatal cases.
• The pathophysiology of peritoneal sclerosis is complex and not fully understood.

Purpose of the Study:

• To investigate the nosological entity of peritoneal sclerosis in peritoneal dialysis patients.
• To differentiate between simple sclerosis and sclerosing peritonitis.
• To explore the distinct etiologies and pathogenetic mechanisms.

Main Methods:

• Review of existing literature on peritoneal sclerosis.
• Analysis of frequency, pathology, animal models, etiology, and pathogenesis.
• Comparison of characteristics between simple sclerosis and sclerosing peritonitis.

Main Results:

• Peritoneal sclerosis exhibits a bimodal configuration in frequency, pathology, animal models, etiology, and pathogenesis.
• Simple sclerosis shows minor alterations, low clinical impact, and is reproducible by PD, linked to poor PD biocompatibility.
• Sclerosing peritonitis presents radical anatomical alterations, high mortality, is not reproducible by PD alone, and involves PD-related and unrelated factors.

Conclusions:

• Peritoneal sclerosis may encompass two distinct nosological entities: simple sclerosis and sclerosing peritonitis.
• These conditions differ significantly in their clinical presentation, pathology, and etiology.
• Understanding these distinctions is crucial for accurate diagnosis and management of PD-related peritoneal complications.