Albumin in the nephrotic syndrome

Eadington, D. W.; Plant, William D.; Winney, R. J.

doi:10.1136/bmj.310.6990.1333a

Cited by 10 publications

(10 citation statements)

References 3 publications

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“…At maximal doses of furosemide, albumin did not facilitate any further increments in diuresis or natriuresis. These results concur with the findings of our previous study (11). We used maximal dose of furosemide, 160 mg, to overcome diuretic-resistance.…”

Section: Time (Hr)supporting

confidence: 92%

“…Many of these studies revealed that albumin had an additive diuretic effect. Davison et al and Eadington et al reported positive results, but they did not perform a cross-over study or show any pharmacokinetic data (15,11). Inoue et al reported that effective diuresis was achieved by infusion of the albumin-furosemide complex in analbuminemic rats and hypoalbuminemic patients (2).…”

Section: Discussionmentioning

confidence: 99%

“…Coadministration of albumin with furosemide may improve furosemide delivery and hence diuretic effect by changing the pharmacokinetics of furosemide. Parallel infusion method of albumin and furosemide was refuted by other opinion that optimal efficacy of the combination could be achieved when furosemide was given after infusion of albumin, as the peak furosemide concentrations would then coincide with maximal expansion of plasma volume (3,11). However, we demonstrated previously that a mixed infusion of albumin and furosemide, compared with furosemide alone, did not enhance the diuretic action of furosemide in six nephrotic patients, either pharmacodynamically or pharmacokinetically (12).…”

Section: Introductionmentioning

confidence: 99%

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Does Albumin Preinfusion Potentiate Diuretic Action of Furosemide in Patients with Nephrotic Syndrome?

Han

Kim

et al. 2001

J Korean Med Sci

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The aim of this cross-over study was to investigate whether albumin infusion before furosemide administration could potentiate the diuretic action of furosemide. Seven patients with nephrotic syndrome were given the following infusions in random order on two separate days: 1) a sham solution followed by 160 mg of furosemide, 2) 100 ml of 20% human albumin followed by 160 mg of furosemide. Urine and serum furosemide concentrations were measured by high-performance liquid chromatography. The increment of urine volume was greater in albumin preinfusion than in furosemide alone. However, the increments of sodium and chloride excretions between furosemide alone and albumin preinfusion were not different. No significant differences in the pharmacokinetic parameters between the two treatments were observed: area under the concentration-time curve (AUC: 12.7+/-2.2 vs 15.1+/-4.4 g/ml hr), total plasma clearance (253+/-41 vs 256+/-54 ml/min), volume of distribution (341+/-34 vs 494+/-153 ml/kg), elimination half life (4.0+/-1.1 vs 4.6+/-0.8 hr), and urine furosemide excretion of the administered amount (16.5+/-7.3 vs 7.5+/-1.6%). In conclusion, these data show that albumin preinfusion potentiated diuresis, but not natriuresis, of furosemide without any change in the pharmacokinetics of the agent in patients with nephrotic syndrome.

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Section: Time (Hr)supporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Albumin Preinfusion Potentiate Diuretic Action of Furosemide in Patients with Nephrotic Syndrome?

Han

Kim

et al. 2001

J Korean Med Sci

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“…Reports on the use of albumin with frusemide as a means to increase the diuretic effect of frusemide are chiefly limited to adults [12][13][14][15][16][17][18][19]. There have been only a few studies on this combination in children [9,20].…”

Section: Introductionmentioning

confidence: 99%

Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome

2009

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The contribution of hypoalbuminemia to impaired diuretic responsiveness can be overcome by administering larger doses of loop diuretics. However, the clinical efficacy of the combination of loop-acting diuretics with human albumin remains controversial. In the study reported here, 16 children with nephrotic syndrome and refractory edema were randomized in a cross-over trial to receive either the combination of 20% human albumin and frusemide infusion (HA+FU infusion group) or frusemide infusion alone (FU infusion group). At the end of study, median urine volume was 3.27 [95% confidence interval (CI) 2.04-4.50] ml/kg per hour in the HA+FU infusion group and 1.33 (95% CI 0.79-1.88) ml/kg per hour in the FU infusion group (P = 0.01); the median daily sodium excretion was 58 (95% CI 30-366) mEq and 30 (95% CI 10-122) mEq (P = 0.08), respectively The changes in other variables included weight loss [HA+FU 5.2% (95% CI 3.1-8.8); FU 0.8% (95% CI -1.9 to 4.1); P = 0.006]; urine osmolality [HA+FU 315 (95% CI 220-426) mOsm/kg; FU 368 (95% CI 318-446) mOsm/kg; P = 0.13]; osmolal clearance [HA+FU 1600 (95% CI 916-4140) ml/day; FU 880 (95% CI 510-2105) ml/day; P = 0.01; free water clearance [HA+FU -190 (95% CI -960 to 280) ml/day; FU -162 (95% CI -446 to -70) ml/day; P = 0.18]. The findings from this study suggest that the co-administration of albumin and frusemide infusions is more effective than the administration of frusemide infusion alone in inducing diuresis and natriuresis in patients with nephrotic syndrome.

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“…[6][7][8][9] Among the most common are fluid overload and hyperkalemia due to difficulty adhering to the strict dietary restrictions that must be followed, especially on non-dialysis days. Acidosis frequently occurs because of the kidneys' inability to excrete the daily metabolic acid load, and hyperphosphatemia and hypocalcemia result from phosphate retention and inade- …”

Section: Metabolic Considerationsmentioning

confidence: 99%

Diabetic ketoacidosis in the dialysis-dependent patient: two case reports and recommendations for treatment

Blicker

Herd

Talbot

2004

CJEM

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Albumin in the nephrotic syndrome

Cited by 10 publications

References 3 publications

Does Albumin Preinfusion Potentiate Diuretic Action of Furosemide in Patients with Nephrotic Syndrome?

Does Albumin Preinfusion Potentiate Diuretic Action of Furosemide in Patients with Nephrotic Syndrome?

Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome

Diabetic ketoacidosis in the dialysis-dependent patient: two case reports and recommendations for treatment

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