Second Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
Clin Exp Nephrol. 2010 Aug;14(4):363-6. doi: 10.1007/s10157-010-0271-6. Epub 2010 Feb 26.
A 67-year-old woman was admitted to our hospital because of anasarca due to refractory nephrotic syndrome and chronic renal insufficiency. Laboratory data indicated serum total protein of 4.8 g/dl, albumin of 1.5 g/dl, creatinine of 1.9 mg/dl and BUN of 17 mg/dl. Urinary protein excretion was 7.8 g/day. Because of severe atrophy of both kidneys, neither renal biopsy nor immunosuppressive treatment was performed. Since conservative management including bed rest, diet therapy, limitation of water intake and administration of diuretics was not effective, peritoneal dialysis therapy using icodextrin only at night was started. The amount of water removal was steadily secured without progressing renal dysfunction or decreasing urine volume. From day 290 onward, the urinary protein excretion was decreased to show complete remission and urine volume increased. On day 528, peritoneal dialysis was discontinued, and thereafter only peritoneal lavage was performed. On day 858, the catheter was removed from the abdominal cavity, and thereafter diuretics could be discontinued. The reason for the dramatic reduction of urinary protein in this patient is unclear. However, it is possible that the primary disease such as membranous nephritis showed remission while the patient was undergoing icodextrin peritoneal dialysis, which preserves renal function but not extracorporeal ultrafiltration or hemodialysis. Icodextrin peritoneal dialysis may be an alternative to hemodialysis for refractory fluid overload in patients with nephrotic syndrome and may have the advantage of preserving renal function.
一位 67 岁女性因难治性肾病综合征和慢性肾功能不全导致全身水肿而入院。实验室数据显示血清总蛋白为 4.8g/dl，白蛋白为 1.5g/dl，肌酐为 1.9mg/dl，BUN 为 17mg/dl。尿蛋白排泄量为 7.8g/天。由于双侧肾脏严重萎缩，未进行肾活检或免疫抑制治疗。由于包括卧床休息、饮食疗法、限制水分摄入和利尿剂在内的保守治疗无效，开始仅在夜间使用艾考糊精进行腹膜透析治疗。在不进展肾功能不全或减少尿量的情况下，稳定地去除水分。从第 290 天开始，尿蛋白排泄量减少，达到完全缓解，尿量增加。第 528 天，停止腹膜透析，此后仅进行腹膜灌洗。第 858 天，将导管从腹腔中取出，此后可以停止使用利尿剂。该患者尿蛋白急剧减少的原因尚不清楚。然而，有可能在进行艾考糊精腹膜透析时，膜性肾病等原发性疾病出现缓解，这种透析方式可以保留肾功能，但不进行体外超滤或血液透析。对于肾病综合征伴难治性液体超负荷的患者，艾考糊精腹膜透析可能是血液透析的替代疗法，并且具有保留肾功能的优势。
