Laboratory Investigation

Kidney International (1989) 36, 1029–1036; doi:10.1038/ki.1989.297

Platelet activating factor is produced during infectious peritonitis in CAPD patients

Giuseppe Montrucchio, Filippo Mariano, Pier Luigi Cavalli, Ciro Tetta, Giusto Viglino, Giorgio Emanuelli and Giovanni Camussi

Clinica Medica III, Ospedale S. Luigi Gonzaga, Torino; Servizio di Nefrologia e Dialisi, Ospedale S. Lazzaro, Alba; Laboratorio di Immunopatologia, Cattedra di Nefrologia Torino; and Cattedra di Nefrologia Sperimentale, Departimento di Biochemica e Biofisica, I Facoltá di Medicina e Chirurgia, Universitá di Napoli, Napoli, Italy

Correspondence: Giovanni Camussi MD, Laboratorio di Immunopatologia, Ospedale Maggiore S. Giovanni Battista, Molinette, C.so Polonia 14, Torino, Italy.

Received 13 March 1989; Revised 3 July 1989; Accepted 12 July 1989.

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Abstract

Platelet activating factor is produced during infectious peritonitis in CAPD patients. Peritonitis, a frequent complication of continuous ambulatory peritoneal dialysis (CAPD), is a model of inflammation which provides the opportunity to recover the exudate fluid. To date, various endogenous mediators (histamine, bradykinin, activated complement factors, prostanoids) have been implicated in the mediation of peritoneal inflammation and increased peritoneal permeability. In the present study, a lipid compound with physicochemical and biological characteristics similar to platelet activating factor (PAF) (1-0-alkyl-2-acetyl-sn-glyceryl-3-phosphorylcholine) was extracted in significant amounts from the dialysate of eight out of nine peritonitis episodes in seven CAPD patients (Group A; 6771.4 plusminus 3025.9 pM, mean plusminus SEM at the first exchange during peritonitis). The amounts of PAF recovered in the first exchange dialysate from patients of Group A were linearly correlated with the loss of albumin (y = -3157.64 + 91.41x; r = 0.7394; N = 9; P < 0.03) and number of leukocytes (y = 902.45 + 1.52x; r = 0.7576 N = 9; P < 0.02). PAF was not detectable in the dialysate fluid from patients of Group A after recovery. Twelve patients on CAPD who had no past or present history of peritonitis (Group B) were used as controls; no PAF (9 patients) or only minimal amounts (3 patients: 7.0 pM; 23.0 pM; 70.0 pM) of this mediator were detected. This is the first direct demonstration of the local generation of PAF in a septic inflammatory reaction involving the peritoneal serosa in man. PAF produced by various cell types (neutrophils, peritoneal macrophages, endothelial cells) during peritoneal inflammation may contribute to the increased permeability of the peritoneal vascular bed.

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