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Treatment of severe edema in children with nephrotic syndrome with diuretics alone--a prospective study

Gaurav Kapur1, Rudolph P Valentini, Abubakr A Imam

  • 1Carman and Ann Adams Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA. gkapur@med.wayne.edu

Clinical Journal of the American Society of Nephrology : CJASN
|May 2, 2009
PubMed

Insights

Fractional excretion of sodium (FeNa) helps differentiate volume contraction from volume expansion in children with nephrotic syndrome. Diuretics alone are safe and effective for treating volume expansion edema.

Area of Science:

  • Pediatric Nephrology
  • Clinical Research
  • Biomarker Analysis

Background:

  • Severe edema in nephrotic syndrome (NS) can stem from volume contraction (VC) or volume expansion (VE).
  • Current treatment with IV albumin and diuretics suits VC but risks fluid overload in VE.
  • This study aimed to assess diuretics alone for severe edema in NS.

Purpose of the Study:

  • To evaluate the efficacy and safety of using diuretics alone to treat severe edema in children with nephrotic syndrome.
  • To determine if fractional excretion of sodium (FeNa) can reliably distinguish between volume contraction and volume expansion in these patients.

Main Methods:

  • A prospective, two-phase study involving 30 children with NS and severe edema.
  • Fractional excretion of sodium (FeNa) <1% initially diagnosed VC; a refined FeNa <0.2% was used in phase 2.
  • Treatment varied: IV albumin and furosemide for VC, IV furosemide and oral spironolactone for VE.

Main Results:

  • FeNa effectively differentiated VC from VE, with VC patients exhibiting higher BUN, BUN/creatinine ratio, urine osmolality, and lower FeNa and urine sodium.
  • VC patients showed elevated renin, aldosterone, and antidiuretic hormone levels.
  • In phase 2, 11 VE patients treated with diuretics alone and 9 VC patients treated with albumin and furosemide showed no significant difference in hospital stay or weight loss.

Conclusions:

  • Fractional excretion of sodium (FeNa) is a valuable tool for distinguishing volume contraction from volume expansion in pediatric nephrotic syndrome with severe edema.
  • Administering diuretics alone to VE patients with nephrotic syndrome is a safe and effective treatment strategy.
Abstract

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