Hemodynamic and volume changes by ultrafiltration in refractory edema of diabetic nephrotic syndrome with severe renal insufficiency.

Effects of ultrafiltration (UF) were examined in 6 diabetic nephrotics having refractory edema. Plasma volume (PV) was 139% of the normal control before and significantly reduced to 125% N after UF (p less than 0.05). Average reduction of PV was 0.3 l, while that of body weight was 4.4 kg. This means that UF induces mainly the reduction of extracellular fluid volume with very little effect on blood volume due to high intravascular refilling. Hemodynamically, cardiac index decreased and total peripheral resistance index (TPRI) remained unchanged according to the decrease of mean blood pressure (MBP). Change in MBP was linearly correlated to that in TPRI. The present study indicates that UF leads to interstitial fluid volume depletion and blood pressure reduction in diabetic nephrotics with severe renal insufficiency. Clinically, UF is a temporary relief from a life-threatening generalized edema in these patients, although neither the progress of renal dysfunction or the recurrence of nephrotic syndrome can be prevented.