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Does albumin and furosemide therapy affect plasma volume in nephrotic children?
Z Bircan1, M Kervancioğlu, S Katar
1Kartal Training and Research Hospital, Istanbul, Turkey. zbircan@superonline.com
Insights
Albumin and furosemide therapy transiently increase plasma volume (PV) in nephrotic children. This effect returns to baseline within 24 hours, alongside reduced edema and body weight.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Nephrotic edema is characterized by fluid accumulation.
- Albumin infusions can temporarily expand plasma volume (PV) and oncotic pressure.
- Restoring diuretic responsiveness is crucial in managing nephrotic edema.
Purpose of the Study:
- To assess the impact of albumin and furosemide therapy on plasma volume in pediatric nephrotic edema.
- To evaluate changes in clinical parameters and echocardiographic indices following treatment.
Main Methods:
- 14 severely edematous children with minimal change nephrotic syndrome were studied.
- Standard clinical parameters (heart rate, blood pressure, body weight, edema, abdominal circumference) were monitored.
- Echocardiography assessed inferior vena cava index (IVCI) and collapsibility index (IVCCI) before, 1 hour, and 24 hours post-therapy.
Main Results:
- Albumin and furosemide therapy significantly increased IVCI and decreased IVCCI 1 hour post-treatment.
- Edema and hematocrit showed significant decreases 1 hour after therapy.
- These PV-related effects were transient, returning to baseline at 24 hours.
- Body weight, abdominal circumference, and edema significantly decreased at 24 hours.
Conclusions:
- Albumin and furosemide therapy provides a transient increase in plasma volume in pediatric nephrotic edema.
- The therapeutic benefits, including reduced edema, manifest by 24 hours.
- This combination therapy effectively manages fluid overload in nephrotic syndrome.
Abstract:
Albumin infusions transiently increase plasma volume (PV) and oncotic pressure, and may restore diuretic responsiveness in nephrotic edema. To determine if albumin and furosemide therapy have an effect on PV in nephrotic children, 14 severely edematous children with minimal change nephrotic syndrome were evaluated with standard clinical parameters (heart rate, blood pressure, body weight, pretibial edema, abdominal circumference) and echocardiography [inferior vena cava index (IVCI), inferior vena cava collapsibility index (IVCCI)] before, 1 h and 24 h after albumin (20%, 0.5 g/kg, 1 h) and furosemide (2 mg/kg, i.v.) therapy. An increase in IVCI (P < 0.05), decrease in IVCCI (P < 0.05), edema (P < 0.005), and hematocrit (P < 0.005) were statistically significant 1 h after albumin and furosemide therapy, with a transient effect 24 h later. Body weight (P < 0.005), abdominal circumference (P < 0.05), and edema (P < 0.005) decreased significantly at 24 h. It is concluded that albumin and furosemide therapy increases PV transiently in nephrotic edema, returning to baseline values at 24 h with a decrease in body weight, abdominal circumference, and edema.