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2012 ; 1
(1
): 16-23
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Successful treatment of icodextrin-single peritoneal dialysis for refractory
nephrotic syndrome induced by idiopathic membranous nephropathy
#MMPMID28509154
Takada D
; Mii A
; Higo S
; Obara Y
; Kurabayashi Y
; Kurosawa N
; Miura S
; Kawachi H
; Shimizu A
CEN Case Rep
2012[May]; 1
(1
): 16-23
PMID28509154
show ga
The patient was a 76-year-old male who developed nephrotic syndrome. Idiopathic
membranous nephropathy was diagnosed by renal biopsy and clinical findings. The
patient had been refractory to predonisolone and cyclosporine A therapies, and
overhydration recurred repeatedly during the clinical course. One year after an
initial hospitalization, he had to be hospitalized a second time because of
overhydration. During the hospitalization, he underwent fluid removal by the
extracorporeal ultrafiltration method (ECUM), as his response to diuretics was
too weak to permit the control of cardiac insufficiency. The ECUM alleviated his
overhydration, but no remission of nephrotic syndrome was achieved. The patient
was then discharged temporarily, but overhydration developed again 2 months
later. Peritoneal dialysis (PD) using an overnight dwell of a single dose of
icodextrin was initiated to obtain stable fluid removal. This promptly alleviated
the refractory subcutaneous edema, and type I incomplete remission of nephrotic
syndrome was achieved about 2 weeks after the start of PD. The patient could be
withdrawn from the PD therapy 4 months later. Subsequently, the urinary volume
was maintained and the serum creatinine level was stabilized at about 2 mg/dl. In
our patient, the protein leakage into the drainage was small enough to permit
remission of the nephrotic syndrome with stable fluid removal. On this basis, we
believe that PD using icodextrin is considered as one of the options for the
treatment of refractory nephrotic syndrome with poor water control.