Intravenous Albumin and Diuretic in Nephrotic Syndrome with Severe Edema:Our Experience and Literature Review

Steroids are the mainstay of initial treatment in children with Idiopathic Nephrotic Syndrome (INS). The role of diuretics in children with NS is less clear in comparison to adults. In cases with severe or refractory edema, furosemide is often combined with albumin infusion (0.5 to 1 g/kg) to provide symptomatic relief.

This study was a retrospective chart review of 17 patients with a diagnosis of Steroid Dependent Nephrotic Syndrome (SDNS) admitted for relapse of NS with severe edema who were resistant to diuretictherapy alone. The patients were treated as per unit protocol with an infusion of 100 ml intravenous albumin 20% over 4 hours and 2 doses (one in the morning at 10 AM and the other in the evening at 6 PM) of furosemide 1mg/kg for 3 days. Response to therapy and adverse events were evaluated.

The mean age of the study population was 10.58±1.5 years. All of the patients had severe edema and none of them had responded to intravenous diuretics alone. After co-administration of intravenous albumin infusion and furosemide, the mean weight loss per day per patient was 0.87±0.16 kg.

A significant improvement was noted in all of the patients following co-administration of albumin and furosemide without any adverse events