Utility of Clinical, Laboratory, and Radiological Parameters for Detecting Hypovolemia in Edematous Children With...

A prospective observational study was conducted in 90 edematous children with steroid-sensitive nephrotic syndrome (SSNS) to determine the prevalence of hypovolemia and also to study the role of surrogate markers like severe edema, high hematocrit, inferior vena cava collapsibility index (IVCCI) ≥ 50%, blood urea/creatinine ≥ 100 : 1, and serum albumin < 1.5 gm/dL in identifying hypovolemia. The diagnostic test for hypovolemia was a combination of FeNa < 0.5 and urinary potassium (UK) index ≥ 0.6. One-third of children with SSNS had hypovolemia, of which 50% were symptomatic. High hematocrit was the most sensitive surrogate marker of hypovolemia (80%), followed by serum albumin < 1.5 g/dL (56.6%), IVCCI ≥ 50% (43%), severe edema (36.7%), and blood urea/creatinine ≥ 100 : 1 (33.3%). The specificity for detecting hypovolemia was maximum for IVCCI ≥ 50% (91.6%), followed by blood urea/creatinine ≥ 100 : 1 (90%), serum albumin < 1.5 g/dL (85%), severe edema (81.7%), and hemoconcentration (21.6%).