[The treatment of refractory edema]

The principle therapy for edema should be targeted to the treatment of the primary disease. However, supportive care is required in most of cases. When effective circulating blood volume is increased, the use of a diuretic medicine is the main treatment strategy. Nevertheless, it is not enough to prevent respiratory and cardiovascular failure in some patients and immediate blood purification therapy, such as extracorporeal ultrafiltration method (ECUM), is required. When the cardiac function is poor, continuous therapy such as continuous hemodiafiltration (CHDF) or continuous hemofiltration (CHF) could be selected with stable circulatory effect. Furthermore, plasma exchange or low density lipoprotein (LDL) apheresis could be a candidate for refractory nephroses, such as primal focal segmental glomerulosclerosis and can induce partial or complete remission.