Abstract
Background: Refractory oedema remains a challenge in nephrotic syndrome patients. Repeated
paracentesis sometimes results in hypotension and invariably acute kidney injury. Intravenous reinfusion of ascitic fluid, a modified form of peritoneo-venous shunt (MPVS) is an alternative treatment modality targeted at preventing haemodynamic instability and correction of hypoproteinemia. We assessed the usefulness and safety of MPVS among nephrotic syndrome
patients with refractory oedema.
Methods: Twenty six consecutive patients with refractory oedema were recruited. A total of 165 sessions of MPVS were performed using peripheral vein. Evaluation of treatment was done by assessment of weight, abdominal girth, urine volume, urinary protein and serum protein. Renal biopsy was performed to determine histological diagnosis. Data were analyzed using statistical
package for social sciences (SPSS) version 16.
Results: Compared to baseline parameters, the median weight (58.5 versus 85.5 kg, p<0.001); abdominal girth (89.3 versus 110.0 cm, p<0.001); and urinary protein excretion (1.7 versus 5.2 g/24hrs, p<0.001) at 8 weeks follow up were significantly lower while the serum albumin (28.0 versus 19.7 g/L, p<0.001) and urinary output (3050.0 versus 785.0 mls, p<0.001) at 8 weeks
follow up were significantly higher. The mean percentage reduction in weight, abdominal girth, urinary protein excretion, percentage increase in urinary output as well as increase in serum albumin levels at the end of the same period were 28.2%, 16.6%, 43.3%, 251.5% and 34.4%, respectively. None of the patients bled from drainage site or developed intra-abdominal
haemorrhage. No mortality was recorded.
Conclusion: Modified peritoneo-venous shunt using a peripheral vein is a novel, effective and safe technique for treating refractory oedema in nephrotic syndrome.
Keywords: Abdominal paracentesis, Intravenous re-infusion of ascites, Nephrotic syndrome, Peritoneo-venous shunt, refractory oedema
Résumé
Contexte : L’œdème réfractaire reste problématique chez les patients atteints du syndrome néphrotique. Une paracentèse répétée entraîne parfois une hypotension et des lésions rénales invariablement aiguës. La ré-infusion intraveineuse de liquide ascitique, une formemodifiée de shunt péritonéo-veineux (MPVS), est une alternative de traitement visant à prévenir
l’instabilité hémodynamique et à corriger l’hypo-protéinémie. Nous avons évalué l’utilité et l’innocuité du MPVS chez les patients atteints du syndrome néphrotique présentant un œdème réfractaire.
Méthodes : Vingt-six patients consécutifs présentant un œdème réfractaire ont été recrutés. Un total de 165 sessions de MPVS a été réalisées en utilisant la veine périphérique. L’évaluation du traitement a été effectuée en fonction du poids, de la circonférence abdominale, du volume des urines, des protéines urinaires et des protéines sériques. Une biopsie rénale a été réalisée pour déterminer le diagnostic histologique. Les données ont été analysées à l’aide du logiciel
statistique pour les sciences sociales (SPSS) version 16.
Résultats : Comparé aux paramètres de base, le poids médian (58,5 kg contre 85,5 kg, p <0,001) ; circonférence abdominale (89,3 versus 110,0 cm, p <0,001) ; et l’excrétion urinaire de protéines (1,7 versus 5,2 g / 24h, p <0,001) à 8 semaines de suivi étaient significativement plus faibles alors que l’albumine sérique (28,0 versus 19,7 g / L, p <0,001) et le débit urinaire (3050,0 versus
785,0 ml, p <0,001) à 8 semaines de suivi étaient significativement plus élevés. Le pourcentage moyen de réduction du poids, du tour de taille abdominal, de l’excrétion des protéines urinaires, de l’augmentation du pourcentage du débit urinaire ainsi que de l’augmentation des taux d’albumine sérique à la fin de la même période était de 28,2%, 16,6%, 43,3%, 251,5% et 34,4%,
respectivement. Aucun des patients n’a saigné du site de drainage ni développé d’hémorragie intraabdominale. Aucune mortalité n’a été enregistrée.
Conclusion : Le shunt péritonéo-veineux modifié utilisant une veine périphérique est une nouvelle technique efficace et sûre pour traiter l’œdème réfractaire dans le syndrome néphrotique.
Mots-clés : Paracentèse abdominale, Ré-infusion intraveineused’ascite,Syndrome néphrotique, Dérivation péritonéo- veineuse, œdème réfractaire.
Correspondence: Prof. F.A. Arogundade, Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria. E-mail: fatiu3@yahoo.com. fatiuaro@oauife.edu.ng
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