| 特集名 | 腎不全患者の血液浄化療法の選択 | |
|---|---|---|
| 題名 | 日常遭遇する病態と血液浄化療法の選択 (7) 感覚器疾患 | |
| 発刊年月 | 2000年 01月 | |
| 著者 | 前波 輝彦 | 聖マリアンナ医科大学腎臓・高血圧内科 |
| 著者 | 安田 隆 | 聖マリアンナ医科大学腎臓・高血圧内科 |
| 著者 | 山川 宙 | 聖マリアンナ医科大学腎臓・高血圧内科 |
| 著者 | 関谷 秀介 | 聖マリアンナ医科大学腎臓・高血圧内科 |
| 【 要旨 】 | 透析導入患者の高齢化とともに糖尿病による導入が増加し，緑内障や糖尿病性網膜症などの視力障害，突発性難聴などの感覚器障害に遭遇する機会が多くなった． 緑内障や眼圧の高い場合には，透析後の浸透圧不均衡による眼房水増加を想定し，浸透圧を規定する溶質を緩徐に除去する血液濾過や血液濾過透析を用いる．眼底出血の急性期には抗凝固薬としてメシル酸ナファモスタットを用いる．出血吸収過程や糖尿病性網膜症では眼底出血の予防のため低分子へパリンを用いる．また，抗凝固薬不要で溶質除去が緩徐なCAPDも選択肢となるかもしれない．今後はacetate free biofiltrationの適応も注目される． 突発性難聴については，その急性期には眼疾患に準じた血液浄化療法の選択を念頭に入れる． |
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| Theme | The Choice of Blood Purification for the Patients with Renal Failure | |
|---|---|---|
| Title | Sensory organ disorders | |
| Author | Teruhiko Maeba | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Takashi Yasuda | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Hiroshi Yamakawa | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Syusuke Sekiya | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| [ Summary ] | In association with the increase in the number of patients with advanced age and diabetes in dialysis patients, management of the patients with sensory disturbance has become an important issue. Here, I describe appropriate modification of hemopurification methods in patients with sensory disturbances including glaucoma, retinopathy, and sudden deafness. Hemofiltration or hemodiafiltration is generally offered to patients with glaucoma or elevated intraocular pressure in order to avoid significant change in plasma osmotic pressure during dialysis therapy. A decrease in plasma osmotic pressure during hemodialysis induces an increase in intracellular water volume causal to dialysis-disequilibrium symptoms, leading to attenuation of fluid outflow from eye. Therefore, the application of normal hemodialysis in patients with acute glaucoma should be avoided. The modality of anticoagulants is important in patients with retinal hemorrhage. Nafamostat mesilate is the most suitable anticoagulant for the patients with acute retinal hemorrhage. Low molecular heparin is also available for patients in the absorption phase of retinal hemorrhage and severe diabetic retinopathy. CAPD is another option for such patients, as its effect are independent of anticoagulant. In addition, acetate free biofiltration may be beneficial for its advantage on significant hemodynamic stability. The concept involved in the management of patients with acute sudden deafness is identical to that described above; that is, minimizing the instability of hemodynamics as well as sigtlificant changes in plasma osmotic pressure during hemopurification. |
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