Refractory oedema treated with modified peritoneo-venous shunt in Nephrotic Syndrome Patients

Abstract

background: Refractory oedema remains a challenge in nephrotic syndrome patients. Repeated paracentesis sometimes results in hypotension and invariably acute kidney injury. Intravenous re-infusion 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 f 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 scrum 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 mis, 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.