Abstract
The treatment with ultrafiltration is effective in rerrnving excess fluid of overhydrated patients secondary to nephrotic syndrome, chronic renal failure, congestive heart failure or liver cirrhosis. We report here a 34- year- old man suffering from steroid resistant nephrotic syndrome due to membranous and diabetic nephropathy. He gained 20kg during 2 months since admission, in spite of various treatment and suffered from dyspnoea and abdominal pain. Twenty- nine litre of fluid was ultrafiltrated under supplementation of colloidal fluid by 6 trials in 7 days. Hemodynamic changes were observed using Swan- Ganz thermodilution catheter. After each treatment, colloidal osmotic pressure increased and hematocrit value decreased, suggesting the efficient transfer of extracellular fluid into blood vessel and expansion of circulating blood volume. Cardiac function did not change during fluid removal below 4 litre. After the fluid removal of 7 litre, CI and PCWP decreased 12% and 12mmHg each. LVSWI SVR and PVR increased 13%, 36% and 31% individually. MAP did not change significantly. GFR decreased 28%. General condition of the patient is extremely improved after the treatment.
