Tissue distribution of hyalinazing vasculopathy lesions in peritoneal dialysis patients

Uremia is considered capable of inducing structural anomalies of the peritoneum, including hyalinizing vasculopathy (HV). To further elucidate the contribution of uremia to the severity of HV, we performed an autopsy study of peritoneal dialysis (PD) patients with severe peritoneal HV lesions. Uremia is a systemic condition and, if capable of inducing HV, it will be expected to be detected outside the peritoneum. Seven autopsy cases of PD patients showing prominent peritoneal HV lesions were selected. Histological slides from the peritoneum, abdominal organs, heart and pericardium, lungs, visceral pleura, and central nervous system were reviewed. Peritoneal lesions were intense in all patients with prominent HV, fibrosis, and a variable presence of inflammation, fibrin, and calcification. Except for focal HV lesions in the intestinal submucosa of one diabetic patient, HV lesions were limited to the peritoneal membrane. None of the other extraperitoneal tissues showed such lesions. In conclusion, extraperitoneal vessels of PD patients show no relevant HV lesions when compared to peritoneal ones. This observation suggests that PD-related factors are the main contributors to the severity of vasculopathy. Uremia may participate in the development of the lesion but it does not seem to be responsible for its severity.