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REVIEWS AND ORIGINAL ARTICLES |
From the Nephrology Department, St. Martin Hospital, Genoa, Italy.
To evaluate peritoneal immunological defenses and to find a way to prevent
peritonitis we have studied the capacity of peritoneal dialysis effluent (PDE)
to opsonize bacteria, and the phagocytic activity of peritoneal macrophages
(PM). The subjects were 40 uremic patients followed for a mean period of 36
months and 40 normal women who underwent laparoscopy (controls).
Opsonic capacity for Staphylococcus epidermidis of undiluted PDE
from CAPD patients with low peritonitis incidence (LPI) proved to be similar
to that of 10% control serum. However, the capacity of effluent from patients
with a high peritonitis incidence (HPI) was noticeably inferior. In these
cases, IgG concentration in PDE was lower than in LPI patients.
There was a significant correlation between opsonization capacity for
bacteria and IgG concentration values in PDE. We found inverse correlations
between opsonic capacity of PDE and number of episodes of peritonitis.
Phagocytic capacity of PM from CAPD patients was similar to that of control
PM when micro-organisms were preopsonized by control serum.
Treatment with intraperitoneal intmunoglobulin raised PDE opsonization
capacity and lowered the incidence in those with previous HPI, thus
demonstrating the importance of abnormal opsonization in CAPD peritonitis and
the possibility of preventing infection by prophylaxis with intraperitoneal
immunoglobulin. Intravenous immunoglobulin does not reduce the incidence of
infection.
KEY WORDS: Opsonins; Peritoneal phagocytic cells; Immunoglobulins; Peritoneal antibacterial defense; Bacterial peritonitis.
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