Peritoneovenous shunting for refractory ascites results in worsening of nephrotic syndrome

Akinobu Takaki; Yohei Maeshima; Takahito Yagi; Akihiro Katayama; Norikazu Hinamoto; Shigeru Akagi; Hitoshi Sugiyama; Takeshi Tomoda; Yoshiaki Iwasaki; Tetsuya Yasunaka; Fusao Ikeda; Yasuhiro Miyake; Haruhiko Kobashi; Atsushi Hirano; Hirofumi Makino; Kazuhide Yamamoto

doi:10.1111/j.1872-034X.2012.01012.x

Peritoneovenous shunting for refractory ascites results in worsening of nephrotic syndrome

Akinobu Takaki, Yohei Maeshima, Takahito Yagi, Akihiro Katayama, Norikazu Hinamoto, Shigeru Akagi, Hitoshi Sugiyama, Takeshi Tomoda, Yoshiaki Iwasaki, Tetsuya Yasunaka, Fusao Ikeda, Yasuhiro Miyake, Haruhiko Kobashi, Atsushi Hirano, Hirofumi Makino, Kazuhide Yamamoto

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Peritoneovenous shunt (PVS) is accepted as a treatment for refractory ascites due to liver cirrhosis. Infection is a well-known complication of shunting. However, the effects of PVS in terms of complications for renal disease are unclear. We encountered a case involving a 52-year-old man with alcoholic liver cirrhosis and complications of nephrotic syndrome that were worsened by PVS. He received PVS for refractory ascites due to alcoholic liver cirrhosis before coming to our hospital for evaluation for liver transplantation. Nephrotic syndrome was then identified due to cirrhosis-related membranoproliferative glomerulonephritis (MPGN). Prednisolone was administrated at 60mg/day for MPGN. On day 5, he showed grade IV hepatic encephalopathy (West Haven criteria). Tapering prednisolone and intestinal cleansing with lactulose treatment improved hepatic encephalopathy, but hyperammonemia persisted and the PVS was removed. After shunt removal, urinary protein levels decreased from 4-6g/day to 0.3-0.5g/day and ammonia levels decreased. PVS may increase the excretion of urinary protein and increase ammonia levels in patients with complications of glomerulonephritis.

Original language	English
Pages (from-to)	1048-1053
Number of pages	6
Journal	Hepatology Research
Volume	42
Issue number	10
DOIs	https://doi.org/10.1111/j.1872-034X.2012.01012.x
Publication status	Published - Oct 2012

Keywords

Liver cirrhosis
Nephrotic syndrome
Peritoneovenous shunt

ASJC Scopus subject areas

Hepatology
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1872-034X.2012.01012.x

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Takaki, A., Maeshima, Y., Yagi, T., Katayama, A., Hinamoto, N., Akagi, S., Sugiyama, H., Tomoda, T., Iwasaki, Y., Yasunaka, T., Ikeda, F., Miyake, Y., Kobashi, H., Hirano, A., Makino, H., & Yamamoto, K. (2012). Peritoneovenous shunting for refractory ascites results in worsening of nephrotic syndrome. Hepatology Research, 42(10), 1048-1053. https://doi.org/10.1111/j.1872-034X.2012.01012.x

Takaki, A, Maeshima, Y, Yagi, T, Katayama, A, Hinamoto, N, Akagi, S, Sugiyama, H, Tomoda, T, Iwasaki, Y, Yasunaka, T, Ikeda, F, Miyake, Y, Kobashi, H, Hirano, A, Makino, H & Yamamoto, K 2012, 'Peritoneovenous shunting for refractory ascites results in worsening of nephrotic syndrome', Hepatology Research, vol. 42, no. 10, pp. 1048-1053. https://doi.org/10.1111/j.1872-034X.2012.01012.x

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abstract = "Peritoneovenous shunt (PVS) is accepted as a treatment for refractory ascites due to liver cirrhosis. Infection is a well-known complication of shunting. However, the effects of PVS in terms of complications for renal disease are unclear. We encountered a case involving a 52-year-old man with alcoholic liver cirrhosis and complications of nephrotic syndrome that were worsened by PVS. He received PVS for refractory ascites due to alcoholic liver cirrhosis before coming to our hospital for evaluation for liver transplantation. Nephrotic syndrome was then identified due to cirrhosis-related membranoproliferative glomerulonephritis (MPGN). Prednisolone was administrated at 60mg/day for MPGN. On day 5, he showed grade IV hepatic encephalopathy (West Haven criteria). Tapering prednisolone and intestinal cleansing with lactulose treatment improved hepatic encephalopathy, but hyperammonemia persisted and the PVS was removed. After shunt removal, urinary protein levels decreased from 4-6g/day to 0.3-0.5g/day and ammonia levels decreased. PVS may increase the excretion of urinary protein and increase ammonia levels in patients with complications of glomerulonephritis.",

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AU - Takaki, Akinobu

AU - Maeshima, Yohei

AU - Yagi, Takahito

AU - Katayama, Akihiro

AU - Hinamoto, Norikazu

AU - Akagi, Shigeru

AU - Sugiyama, Hitoshi

AU - Tomoda, Takeshi

AU - Iwasaki, Yoshiaki

AU - Yasunaka, Tetsuya

AU - Ikeda, Fusao

AU - Miyake, Yasuhiro

AU - Kobashi, Haruhiko

AU - Hirano, Atsushi

AU - Makino, Hirofumi

AU - Yamamoto, Kazuhide

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AB - Peritoneovenous shunt (PVS) is accepted as a treatment for refractory ascites due to liver cirrhosis. Infection is a well-known complication of shunting. However, the effects of PVS in terms of complications for renal disease are unclear. We encountered a case involving a 52-year-old man with alcoholic liver cirrhosis and complications of nephrotic syndrome that were worsened by PVS. He received PVS for refractory ascites due to alcoholic liver cirrhosis before coming to our hospital for evaluation for liver transplantation. Nephrotic syndrome was then identified due to cirrhosis-related membranoproliferative glomerulonephritis (MPGN). Prednisolone was administrated at 60mg/day for MPGN. On day 5, he showed grade IV hepatic encephalopathy (West Haven criteria). Tapering prednisolone and intestinal cleansing with lactulose treatment improved hepatic encephalopathy, but hyperammonemia persisted and the PVS was removed. After shunt removal, urinary protein levels decreased from 4-6g/day to 0.3-0.5g/day and ammonia levels decreased. PVS may increase the excretion of urinary protein and increase ammonia levels in patients with complications of glomerulonephritis.

KW - Liver cirrhosis

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Peritoneovenous shunting for refractory ascites results in worsening of nephrotic syndrome

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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