BibTex RIS Cite

Edema: Causes, Pathophysiology and Treatment

Year 2016, Volume: 25 Issue: 1, 97 - 112, 31.03.2016

Abstract

Edema is a nonspecific finding common to a host of diseases. It is defined as a palpable swelling produced by expansion of the interstitial fluid volume. Edema can be a sign of benign or potentially life threatening disease. Systematic approach to the patient with edema allows for prompt diagnosis and treatment. Here, we review the pathophysiology, causes, clinical approach and treatment strategies.

References

  • Elhassan EA, Schrier RW, Disorder of extracellular Volume. In. Comprehensive Clinical Nephrology, 4th ed (Eds J Floege, RJ Johnson, J Feehally):85-99. St Louis, Missouri, Elsevier, 2010.
  • Taylor AE.Capillary fluid filtration. Starling forces and lymph flow. Circ Res. 1981:49:557-75.
  • Scallan J, Huxley VH, Korthuis RJ. Capillary Fluid Exchange: Regulation, Functions, and Pathology. San Rafael (CA), Morgan & Claypool Life Sciences; 2010.
  • Koomans HA, Kortlandt W, Geers AB, Dorhout Mees EJ. Lowered protein content of tissue fluid in patients with the nephrotic syndrome: observations during disease and recovery. Nephron.
  • Bhave G, Neilson EG. Body fluid dynamics: back to the future. J Am Soc Nephrol. 2011;22:2166- 81.
  • Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res. 2010;87:198-210.
  • Sterns RH. Pathophysiology and etiology of edema in adults. UpToDate. Erişim tarihi: 20 mayıs 2015; Available from http://www.uptodate.com/contents/pathophysiology-and-etiology-of- edema-in-adults?source=search_result&search=edema+adult&selectedTitle=3~150
  • Schrier RW. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann Intern Med. 1990;113:155-9.
  • Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577-85.
  • Ginès P, Fernández-Esparrach G, Arroyo V, Rodés J. Pathogenesis of ascites in cirrhosis. Semin Liver Dis. 1997;17:175-89.
  • Rodríguez-Iturbe B, Herrera-Acosta J, Johnson RJ. Interstitial inflammation, sodium retention, and the pathogenesis of nephrotic edema: a unifying hypothesis. Kidney Int. 2002;62:1379-84.
  • Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep. 2002;4:479-82.
  • Noll G, Lüscher TF. Comparative pharmacological properties among calcium channel blockers: T- channel versus L-channel blockade. Cardiology. 1998;89:10-5.
  • Guan Y, Hao C, Cha DR, Rao R, Lu W, Kohan DE et al. Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med. 2005;11:861-6.
  • Pechère-Bertschi A, Burnier M. Female sex hormones, salt, and blood pressure regulation. Am J Hypertens. 2004;17:994-1001.
  • Whelton A, Hamilton CW. Nonsteroidal anti-inflammatory drugs: effects on kidney function. J Clin Pharmacol 1991;31:588–98.
  • Streeten DH. Idiopathic edema: pathogenesis, clinical features, and treatment. Endocrinol Metab Clin North Am. 1995;24:531-47.
  • Streeten DH. Idiopathic edema. Curr Ther Endocrinol Metab. 1997;6:203-6.
  • Blankfield RP, Finkelhor RS, Alexander JJ, Flocke SA, Maiocco J, Goodwin M, et al. Etiology and diagnosis of bilateral leg edema in primary care. Am J Med. 1998;105:192-7.
  • Gorman WP, Davis KR, Donnelly R. ABC of arterial and venous disease. Swollen lower limb-1: general assessment and deep vein thrombosis. BMJ. 2000;320:1453-6.
  • Yale SH, Mazza JJ. Approach to diagnosing lower extremity edema. Compr Ther. 2001;27:242-52.
  • Padberg F Jr, Cerveira JJ, Lal BK, Pappas PJ, Varma S, Hobson RW 2nd. Does severe venous insufficiency have a different etiology in the morbidly obese? is it venous? J Vasc Surg.
  • Buggey J, Mentz RJ, Pitt B, Eisenstein EL, Anstrom KJ, Velazquez EJ, et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J. 2015;169:323-33.
  • Palazzuoli A, Ruocco G, Pellegrini M, Beltrami M, Castillo GD, Nuti R. Loop diuretics strategies in acute heart failure: from clinical trials to practical application. Curr Drug Targets. 2015;PMID:25892312
  • De Vecchis R, Ciccarelli A, Ariano C, Cioppa C, Giasi A, Pucciarelli A et al. In chronic heart failure with marked fluid retention, the i.v.high doses of loop diuretic are a predictor of aggravated renal dysfunction,especially in the set of heart failure with normal or only mildly impaired left ventricular systolic function. Minerva Cardioangiol. 2011;59:543-54.
  • Roush GC, Kaur R, Ernst ME. Diuretics: a review and update. J Cardiovasc Pharmacol Ther. 2014;19:5-13.
  • Brater DC Mechanism of action of diuretics. UpToDate. Erişim tarihi: 20 mayıs 2015. Available fromhttp://www.uptodate.com/contents/mechanism-of-action-of-diuretics? source=search_ result&search= diuretics& selectedTitle=1~150
  • Felker GM, Mentz RJ. Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol. 2012;59:2145-53.
  • Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens. 2011;13:639-43.
  • Allen LA, Turer AT, Dewald T, Stough WG, Cotter G, O’ConnorCM. Continuous versus bolus dosing of furosemide for patients hospitalized for heart failure. Am J Cardiol. 2010;105:1794-7.
  • Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797-805.
  • Palazzuoli A, Pellegrini M, Ruocco G, Martini G, Franci B, Campagna MS et al. Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial. Crit Care. 2014;18:R134.
  • Kirchner KA, Voelker JR, Brater DC. Intratubular albumin blunts the response to furosemide: a mechanism for diuretic resistance in the nephrotic syndrome. J Pharmacol Exp Ther. 1990;252:1097-101.
  • Agarwal R, Gorski JC, Sundblad K, Brater DC. Urinary protein binding does not affect response to furosemide in patients with nephrotic syndrome. J Am Soc Nephrol. 2000;11:1100-5.
  • Correspondence Address / Yazışma Adresi Rüya Özelsancak
  • Başkent Üniversitesi Tıp Fakültesi
  • Adana Uygulama ve Araştırma Merkezi Nefroloji Kliniği Adana-Turkey.
  • e-mail: rusancak@hotmail.com
  • Geliş tarihi/ Received: 02.06.2015
  • Kabul tarihi/Accepted: 04.07.2015

Ödem: Nedenleri, Patofizyolojisi ve Tedavisi

Year 2016, Volume: 25 Issue: 1, 97 - 112, 31.03.2016

Abstract

Ödem klinikte sık olarak karşımıza çıkan ve farklı hastalıklara bağlı olarak gelişen nonspesifik bir bulgudur. İntertisyel sıvı hacminin artışına bağlı olarak gelişen palpe edilebilen şişme olarak tanımlanır. Benign bir sebebe bağlı olabileceği gibi hayatı tehdit eden bir hastalığın bulgusu da olabilir. Sistematik bir yaklaşımla hastalığın teşhisi ve tedavisi sağlanır. Bu derlemede ödemin patofizyolojisini, nedenlerini, klinik yaklaşım ve tedavisini tartıştık.

References

  • Elhassan EA, Schrier RW, Disorder of extracellular Volume. In. Comprehensive Clinical Nephrology, 4th ed (Eds J Floege, RJ Johnson, J Feehally):85-99. St Louis, Missouri, Elsevier, 2010.
  • Taylor AE.Capillary fluid filtration. Starling forces and lymph flow. Circ Res. 1981:49:557-75.
  • Scallan J, Huxley VH, Korthuis RJ. Capillary Fluid Exchange: Regulation, Functions, and Pathology. San Rafael (CA), Morgan & Claypool Life Sciences; 2010.
  • Koomans HA, Kortlandt W, Geers AB, Dorhout Mees EJ. Lowered protein content of tissue fluid in patients with the nephrotic syndrome: observations during disease and recovery. Nephron.
  • Bhave G, Neilson EG. Body fluid dynamics: back to the future. J Am Soc Nephrol. 2011;22:2166- 81.
  • Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res. 2010;87:198-210.
  • Sterns RH. Pathophysiology and etiology of edema in adults. UpToDate. Erişim tarihi: 20 mayıs 2015; Available from http://www.uptodate.com/contents/pathophysiology-and-etiology-of- edema-in-adults?source=search_result&search=edema+adult&selectedTitle=3~150
  • Schrier RW. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann Intern Med. 1990;113:155-9.
  • Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577-85.
  • Ginès P, Fernández-Esparrach G, Arroyo V, Rodés J. Pathogenesis of ascites in cirrhosis. Semin Liver Dis. 1997;17:175-89.
  • Rodríguez-Iturbe B, Herrera-Acosta J, Johnson RJ. Interstitial inflammation, sodium retention, and the pathogenesis of nephrotic edema: a unifying hypothesis. Kidney Int. 2002;62:1379-84.
  • Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep. 2002;4:479-82.
  • Noll G, Lüscher TF. Comparative pharmacological properties among calcium channel blockers: T- channel versus L-channel blockade. Cardiology. 1998;89:10-5.
  • Guan Y, Hao C, Cha DR, Rao R, Lu W, Kohan DE et al. Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med. 2005;11:861-6.
  • Pechère-Bertschi A, Burnier M. Female sex hormones, salt, and blood pressure regulation. Am J Hypertens. 2004;17:994-1001.
  • Whelton A, Hamilton CW. Nonsteroidal anti-inflammatory drugs: effects on kidney function. J Clin Pharmacol 1991;31:588–98.
  • Streeten DH. Idiopathic edema: pathogenesis, clinical features, and treatment. Endocrinol Metab Clin North Am. 1995;24:531-47.
  • Streeten DH. Idiopathic edema. Curr Ther Endocrinol Metab. 1997;6:203-6.
  • Blankfield RP, Finkelhor RS, Alexander JJ, Flocke SA, Maiocco J, Goodwin M, et al. Etiology and diagnosis of bilateral leg edema in primary care. Am J Med. 1998;105:192-7.
  • Gorman WP, Davis KR, Donnelly R. ABC of arterial and venous disease. Swollen lower limb-1: general assessment and deep vein thrombosis. BMJ. 2000;320:1453-6.
  • Yale SH, Mazza JJ. Approach to diagnosing lower extremity edema. Compr Ther. 2001;27:242-52.
  • Padberg F Jr, Cerveira JJ, Lal BK, Pappas PJ, Varma S, Hobson RW 2nd. Does severe venous insufficiency have a different etiology in the morbidly obese? is it venous? J Vasc Surg.
  • Buggey J, Mentz RJ, Pitt B, Eisenstein EL, Anstrom KJ, Velazquez EJ, et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J. 2015;169:323-33.
  • Palazzuoli A, Ruocco G, Pellegrini M, Beltrami M, Castillo GD, Nuti R. Loop diuretics strategies in acute heart failure: from clinical trials to practical application. Curr Drug Targets. 2015;PMID:25892312
  • De Vecchis R, Ciccarelli A, Ariano C, Cioppa C, Giasi A, Pucciarelli A et al. In chronic heart failure with marked fluid retention, the i.v.high doses of loop diuretic are a predictor of aggravated renal dysfunction,especially in the set of heart failure with normal or only mildly impaired left ventricular systolic function. Minerva Cardioangiol. 2011;59:543-54.
  • Roush GC, Kaur R, Ernst ME. Diuretics: a review and update. J Cardiovasc Pharmacol Ther. 2014;19:5-13.
  • Brater DC Mechanism of action of diuretics. UpToDate. Erişim tarihi: 20 mayıs 2015. Available fromhttp://www.uptodate.com/contents/mechanism-of-action-of-diuretics? source=search_ result&search= diuretics& selectedTitle=1~150
  • Felker GM, Mentz RJ. Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol. 2012;59:2145-53.
  • Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens. 2011;13:639-43.
  • Allen LA, Turer AT, Dewald T, Stough WG, Cotter G, O’ConnorCM. Continuous versus bolus dosing of furosemide for patients hospitalized for heart failure. Am J Cardiol. 2010;105:1794-7.
  • Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797-805.
  • Palazzuoli A, Pellegrini M, Ruocco G, Martini G, Franci B, Campagna MS et al. Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial. Crit Care. 2014;18:R134.
  • Kirchner KA, Voelker JR, Brater DC. Intratubular albumin blunts the response to furosemide: a mechanism for diuretic resistance in the nephrotic syndrome. J Pharmacol Exp Ther. 1990;252:1097-101.
  • Agarwal R, Gorski JC, Sundblad K, Brater DC. Urinary protein binding does not affect response to furosemide in patients with nephrotic syndrome. J Am Soc Nephrol. 2000;11:1100-5.
  • Correspondence Address / Yazışma Adresi Rüya Özelsancak
  • Başkent Üniversitesi Tıp Fakültesi
  • Adana Uygulama ve Araştırma Merkezi Nefroloji Kliniği Adana-Turkey.
  • e-mail: rusancak@hotmail.com
  • Geliş tarihi/ Received: 02.06.2015
  • Kabul tarihi/Accepted: 04.07.2015
There are 40 citations in total.

Details

Primary Language English
Journal Section Review
Authors

Rüya Özelsancak

Publication Date March 31, 2016
Published in Issue Year 2016 Volume: 25 Issue: 1

Cite

AMA Özelsancak R. Edema: Causes, Pathophysiology and Treatment. aktd. February 2016;25(1):97-112. doi:10.17827/aktd.05287