Cardiology
Ultrafiltration in Diuretic-Resistant Volume Overload in Nephrotic Syndrome and Patients with Ascites due to Chronic Liver DiseaseDavenport A.Consultant Renal Physician/Honorary Senior Lecturer, Royal Free and University College Hospital Medical School, Centre for Nephrology, Royal Free Hospital, London, UK
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Cardiology 2001;96:190–195
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Article / Publication Details
First-Page Preview
Published online: January 18, 2002
Issue release date: 2001
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 0
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
Abstract
Patients with nephrotic syndrome and those with cirrhosis are predisposed to salt and water retention due to reduced renal sodium excretion. Despite the prescription of low-sodium diets and diuretics, some patients develop refractory oedema. When other medical treatments have been ineffective, isolated ultrafiltration and hemofiltration have been successfully used to treat refractory nephrotic patients. Following fluid removal, patients become responsive to diuretics. In cirrhotic patients, re-infusion of ascites and paracentesis with albumin infusion have been reported to be equally effective in managing ascites refractory to diuretic and other standard therapies. Although isolated ultrafiltration has not been successful in controlling ascitic fluid, hemofiltration has been shown to be beneficial, whereas standard intermittent hemodialysis has been reported to be ineffective.
© 2002 S. Karger AG, Basel
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References
- Fauchald P, Noddeland H, Norseth J: Interstitial fluid volume, plasma volume and colloid osmotic pressure in patients with nephrotic syndrome. Scand J Clin Lab Invest 1984;44:661–667.
- Lowenberg EK, Berg UB: Influence of serum albumin on renal function in nephrotic syndrome. Pediatr Nephrol 1999;13:19–25.
- Andreucci M, Russo D, Fuiano G, Minutolo R, Andreucci VE: Diuretics in renal failure. Miner Electrolyte Metab 1999;25:32–38.
- Rudy D, Voelker J, Greene P, Esparza F, Brater D: Loop diuretics for chronic renal insufficiency: A continuous infusion is more effective than bolus therapy. Ann Intern Med 1991;115:360–366.
- Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Schölmerich J: Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23:164–176.
- Moore K: The hepatorenal syndrome. Clin Sci (Lond) 1997;92:433–443.
- Bataller R, Sort P, Gines P, Arroyo V: Hepatorenal syndrome: Definition, pathophysiology, clinical features and management. Kidney Int Suppl 1998;66:S47–S53.
- Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K: Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 1999;134:1082–1085.
- Iwase K, Takenaka H, Ishizaka T, Ohata T, Oshima S, Sakaguchi K: Serial changes in renal function during laparoscopic cholecystectomy. Eur Surg Res 1993;25:203–212.
- Gines P: Diagnosis and treatment of hepatorenal syndrome. Baillieres Best Pract Res Clin Gastroenterol 2000;14:945–957.
-
Flyvbjerg A, Aagaard NK, Kiszka-Kanowitz M, Bendtsen F: The long acting release formula of octreotide (Octreotide LAR) reduces renal function in compensated cirrhosis. J Am Soc Nephrol 2000;11:132A.
- Harrison PM, Wendon JA, Gimson AES, Alexander GJM, Williams R: Improvement by acetyl cysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med 1991;324:1852–1857.
- Jalan R, Hayes PC: Hepatic encephalopathy and ascites. Lancet 1997;350:1309–1315.
- Antillon MR, Runyon BA: Extracorporeal ultrafiltration and intravenous re-infusion of ascitic fluid vs. large-volume paracentesis: A randomized controlled trial. Hepatology 1993;17:520–522.
- Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D: Surgical shunts and TIPS for variceal decompression in the 1990s. Surgery 2000;128:540–547.
- Smith JD, Hayslett JP: Reversible renal failure in the nephrotic syndrome. Am J Kidney Dis 1992;19:201–213.
-
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercise. Case 4 – 1982. Sudden onset of renal failure and the nephrotic syndrome in a middle-aged woman. N Engl J Med 1982;304:221–225.
- Asab H, Bergström J, Fürst P, Shaldon S, Wiklund S: Treatment of diuretic resistant fluid retention with ultrafiltration. Acta Med Scand 1978;204:145–149.
- Onoyama K, Kumagai H, Fufishima M: Hemodynamic and volume changes by ultrafiltration in refractory edema of diabetic nephrotic syndrome with severe renal insufficiency. Clin Nephrol 1987;27:21–25.
-
Fauchald P, Noddeland H, Norseth J: An evaluation of ultrafiltration as treatment for diuretic resistant edema in nephrotic syndrome. Acta Med Scand 1985;17:127–131.
- Sjoberg RJ, McMillan VM, Bartram LS, Copley JB: Renal failure with minimal change nephrotic syndrome: Reversal with hemodialysis. Clin Nephrol 1983;20:98–100.
-
Fauchald P: Effects of ultrafiltration on body fluid volumes and transcapillary colloid osmotic gradient in hemodialysis patients; in Baldamus CA, Mion C, Shaldon S (eds): Improvements in Dialysis Therapy. Contrib Nephrol. Basel, Karger, 1989, vol 74, pp 170–175.
-
Reiger J: Hemofiltration in a nephrotic syndrome of unknown origin; in Sieberth HG, Stummvoll HK, Kierdorf H (eds): Continuous Extracorporeal Treatment in Multiple Organ Dysfunction Syndrome. Contrib Nephrol. Basel, Karger, 1995, vol 116, pp 53–55.
- Davenport A, Will EJ, Davison AM: Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med 1993;21:328–338.
-
Davenport A: Anticoagulation in patients with acute renal failure treated with continuous renal replacement therapies. Home Hemodial Int 1998;2:41–60.
-
Parbhoo SP, Ajdukiewicz A, Sherlock S: Treatment of ascites by continuous ultrafiltration and reinfusion of protein concentrate. Lancet 1974;i:949–952.
- Lai KN, Leung JWC, Vallance-Owen J: Dialytic ultrafiltration by hemofilter in treatment of patients with refractory ascites and renal insufficiency. Am J Gastroenterol 1987;82:665–668.
- Lai KN, Pun CO, Leung JWC: Study of hepatic venous wedge and intraperitoneal pressures in cirrhotic patients with refractory ascites treated by dialytic ultrafiltration. J Gastroenterol Hepatol 1989;4:325–330.
- Borzio M, Romagnoni M, Sorgato G, Bruno S, Borzio F, Tarasco V, Tetta C, Modignani RL: A simple method for ascites concentration and reinfusion. Dig Dis Sci 1995;40:1054–1059.
- Daimon S, Yasuhara S, Saga T, Tokunaga S, Chikaki H, Dan K: Efficacy of extracorporeal ultrafiltration of ascitic fluid as a treatment of refractory ascites. Nephrol Dial Transplant 1998;13:2617–2623.
-
Lai KN, Li PKT, Law E, Swaminathan R, Nicholls MG: Large-volume paracentesis versus dialytic ultrafiltration in the treatment of cirrhotic ascites. Q J Med 1991;285:33–41.
- Epstein M, Perez GO, Bedoya LA, Molina R: Continuous arterio-venous ultrafiltration in cirrhotic patients with ascites or renal failure. Int J Artif Organs 1986;9:253–256.
- Davenport A: Artificial hepatic support: Where are we now? Blood Purif 2001;19:1–3.
- Hwang JC, Chen JA, Fung HY: Hemodialysis alternative with ascites ultrafiltration for an end-stage renal failure patient associated with tense ascites secondary to decompensated liver cirrhosis. Am J Kidney Dis 1996;28:899–903.
- Catalano C, Fabbian F, Di Landro D: Reinfusion and concentration of ascitic fluid during hemodialysis in a cirrhotic uremic patient. Am J Kidney Dis 1998;32:164–167.
- Asakimori Y, Yorioka N, Kumagai J, Kawanishi H, Tsuchiya S: Direct infusion of ascites into the blood circuit during hemodiafiltration in uremic patients with cirrhosis. Int J Artif Organs 2000;23:232–236.
Article / Publication Details
First-Page Preview
Published online: January 18, 2002
Issue release date: 2001
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 0
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
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