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Category: Volume 07 Issue 03 March 2019
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Title: Albumin and Furosemide vs Furosemide Alone in Severe Edema of Pediatric Nephrotic Syndrome

Authors: Prakash Chandra Panda, K.Arun Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.230

Abstract

Introduction: The treatment of severe edema in a child with nephrotic syndrome is generally managed by furosemide. Hypoalbuminemia diminishes the amount of albumin-bound furosemide and diminishes the furosemide delivery to the ascending limb of the loop of henle and ultimately diminishes the diuretic effect.

Objectives: To compare the therapeutic outcome of albumin and furosemide combination (Intervention group) and furosemide alone (control group) in terms of clinical and biochemical parameters

Methods:  Open labeled Quasi-experimental study was conducted in department of pediatrics VSSIMSAR, Burla from October 2016 to September 2018 after institutional ethics committee approval .40 subjects were included as per predefined inclusion and exclusion criteria, out of which 20 subjects were placed in intervention group and 20 in control group alternatively by random allocation.

Results: Data expressed as mean ± standard deviation. P value <0.05 was considered to be significant. Body weight, abdominal circumference, serum sodium, serum potassium values decreased significantly after receiving respective drugs (at 1hr and 24 hr) as compared to pretreatment value (at 0hr) but the mean difference among both the groups from pretreatment value to 24 hrs after treatment was not statistically significant In both groups urine output increased  significantly after receiving respective drugs as compared to pretreatment and mean difference at 24hrs was found statistically significant. In (F) group serum Albumin decreased significantly at 24 hrs of post treatment as compared to baseline value. In (A+F) group Serum Albumin increased significantly at 24 hrs of post treatment as compared to baseline. In (F) group the mean percentage of inferior vena caval collapsibility index (IVCCI) remains same at 1hr and 24hrs of post treatment but in (A+F) group IVCCI decreased significantly at 1hr but returning to baseline value at 24hrs of post treatment.

Conclusion: The present study conclude that the add on effect of diuretics therapy when co-administrated albumin infusion priming is therapeutically better and equally safe than intravenous furosemide alone in management of severe edema in children with nephrotic syndrome.

Keywords: Nephrotic syndrome, edema, albumin, furosemide.

References

  1. Doucet, G. Favre, andG.Deschˆenes, “Molecular mechanism of edema formation in nephrotic syndrome: therapeutic implications,” Pediatric Nephrology, vol. 22, no. 12, pp.1999, 2007.
  2. Bagga A, Mantan M. Nephrotic syndrome in children. Indian j Med Res 2005;122:13-28
  3. Bagga A, Srivastava RN. Nephrotic syndrome. In: Srivastava RN, Bagga A, editors. Pediatric Nephrology. 4th Newdelhi :jaypee; 2005 p. 159-200.
  4. BRATER DC: Resistance to diuretics: Mechanisms and clinical implications. Adv Nephrol 22:349 2010
  5. C. Brater, “Update in diuretic therapy: clinical pharmacology,” Seminars in Nephrology, vol. 31, no. 6, pp. 483–494, 2011
  6. Smith DE, Hyneck ML, Berardi RR, Port FK. Urinary protein binding, kinet-ics, and dynamics of furosemide in nephritic patients. J Pharm Sci(1985) 74:603.
  7. Inoue, M.; Okajima, K.; Itoh, K.; Ando, Y.; Watanabe, N.; Yasaka, T.; Nagase, S.; Morino, Y. Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients. Kidney Int.2007, 32, 198–203.
  8. Na, K.Y.; Han, J.S.; Kim, Y.S.; Ahn, C.; Kim, S.; Lee, J.S.; Bae, K.S.; Jang, I.J.; Shin, S.G.;Huh, W.; et al. Does albumin preinfusion potentiate diuretic action of furosemide in patients with nephrotic syndrome? Korean Med. Sci. 2009, 16, 448–454.
  9. Rodriguez-Iturbe B, Herrera-Acosta J, Johnson RJ. Interstitial inflammation, sodium retention, and the pathogenesis of nephrotic edema: a unifying hypothesis. Kidney Int (2007) 62:1379–84.
  10. Cadnapaphornchai MA, Tkachenko O, Schrier RW. The nephrotic syndrome: pathogenesis and treatment of edema formation and secondary complications. Pediatr Nephrol(2014) 29:1159–67.
  11. Bockenhauer D. Over- or underfill: not all nephrotic states are created equal. Pediatr Nephrol (2013) 28:1153–6.
  12. Schrier RW, Fassett RG. A critique of the overfill hypothesis of sodium and water retention in the nephrotic syndrome. Kidney Int(2010) 53:1111–7
  13. Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising. Sobczyk D, Nycz K, Andruszkiewicz K, Wierzbicki K, Stapor M. Cardiovasc Ultrasound. 2016;14:23.
  14. Inferior vena cava diameter and collapsibility index: a practical non-invasive evaluation of intravascular fluid volume in critically – ill patients. Thanakitcharu P, Charoenwut m, Siriwiwatanakul N.
  15. Sahana K.S. Clinical profile of nephrotic syndrome in children. Journal of evolution of medical science. 2014; (4): 860-870.

Corresponding Author

K.Arun Kumar

PG Student, Department of Pediatrics, VSSIMSAR, Sambalpur, Odisha

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