| Theme | Dialysis Therapy and Respiratory Systems | |
|---|---|---|
| Title | Pulmonary edema | |
| Publish Date | 1997/12 | |
| Author | Takashi Harada | Second Department of Internal Medecine, Nagasaki University School of Medecine/ Division of Cardiology, Kitakyusyu City Yahata Hospital |
| [ Summary ] | Water flux from pulmonary capillaries to pulmonary interstitial tissue increases in some specific conditions including increased capillary pressure and the increased capillary permeability. When this influx rate is greater than the water removal capacity of the lymph system or other systems, the net water influx into interstitial tissue causes pulmonary edema. In chronic renal failure patients, the primary factor causing pulmonary edema is increased intravascular pressure due to the increased water and/or sodium load. Effective ultrafiltration might contribute to the decreased water content within pulmonary interstitial tissue. However, there are also many other factors that contribute to the increased extravascular lung water in patients with chronic renal failure, including the increased cardiac load due to anemia, hypertension, internal shunt, priming volume, etc. ; and accumulation of dialysis membrane activated neutrophils in pulmonary capillaries. These factors may significantly affect the complex response of lung water to hemodialysis treatment. We evaluated the change in extravascular lung water (EVLW) during hemodialysis in patients with chronic renal failure using the heat-sodium double indicator dilution method. In most cases, the EVLW before dialysis showed a higher level which decreased significantly after dialysis. In approximately half of the case, however, the EVLW increased transiently during dialysis. This phenomenon suggests that, in addition to the increased intravascular pressure, there may be other factors contributing to the development of pulmonary edema. |
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