Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Kapur, Gaurav; Valentini, Rudolph P.; Imam, Abubakr; Mattoo, Tej K.

doi:10.2215/cjn.04390808

Cited by 70 publications

(57 citation statements)

References 26 publications

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“…Kapur et al (20) defined as hypovolemic the patients who had FENa of <1%. However, in phase 2 of their study, the FENa criterion for the volume status was modified and patients with FENa of <0.2% were identified with volume contraction.…”

Section: Discussionmentioning

confidence: 99%

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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Background/aim: The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes.Materials and methods: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods.Results: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients. Conclusion:The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients.

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Section: Discussionmentioning

confidence: 99%

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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“…Aggressive use of high dose diuretics to achieve fast resolution of oedema usually ends with intravascular hypovolaemia or its exacerbation [2] [3] [4] [5] [6].…”

Section: Discussionmentioning

confidence: 99%

“…In the underfill hypothesis, severe hypoalbuminaemia decreases intravascular oncotic pressure, causing circulatory volume depletion and subsequent sodium and water retention [2] [3] [4] [5] [6]. The reduction in plasma oncotic pressure also causes transudation of fluid from the intravascular to the interstitial space.…”

Section: ) Edemamentioning

confidence: 99%

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Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation

Okoronkwo¹,

Onyearugha²,

Ogbonna³

2018

CRCM

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Background: Oedema, a constant feature of childhood nephrotic syndrome can be severe, enough to cause respiratory embarrassment. It can also be refractory to diuretic monotherapy. In such cases, combination of salt poor albumin (SPA) infusion and diuretics has remained the best treatment option. However, the cost of SPA has made it practically unavailable in resource-poor settings. It becomes a therapeutic dilemma when nephrotic syndrome patients of financially-constrained caregivers present with refractory anasarca in a resource-poor settings. Case review: We present a seven-year-old boy with relapsed steroid sensitive nephrotic syndrome who presented to Abia State University Teaching Hospital Aba, in respiratory distress with anasarca and a weight of 58 kilograms. SPA could not be accessed due to financial constraints. A decision to use fresh whole blood in the place of SPA, in combination with frusemide, achieved a lifesaving diuresis and regression of the anasarca. Conclusion: Whole blood is a good alternative for the treatment of refractory oedema in children with nephrotic syndrome in resource poor settings.

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“…Salah satu penelitian bahkan menunjukkan bahwa pemberian furosemid saja dapat memberikan efek positif terhadap pasien SN dengan edema berat. 6 Akan tetapi, penelitian yang mendukung pemberian furosemid tunggal pada SN dengan hipoalbuminemia dan edema tersebut masih dalam level of evidence 3 dengan jumlah subyek penelitian kecil. Walaupun Ghafari 9 dan Dharmaraj 8 berhasil menunjukkan adanya perbaikan natriuresis dan diuresis pada pemberian kombinasi albumin dan furosemid dibanding pemberian furosemid saja, efek tersebut hanya terjadi dalam waktu yang sementara dan tidak berlanjut memberikan efek perbaikan yang diharapkan.…”

Section: Pembahasanunclassified

Transfusi Albumin dan Furosemid pada Pasien Sindrom Nefrotik Anak dengan Edema

Utami¹,

Tambunan²

2017

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Latar belakang. Pemberian albumin pada anak dengan sindroma nefrotik (SN) serta edema dapat meningkatkan tekanan osmotik dan menarik cairan ekstraselular kembali ke dalam kompartemen vaskular sehingga mengurangi edema. Namun, beberapa penelitian terhadap pasien dewasa mendapatkan bahwa mekanisme intrarenal bertanggung jawab terhadap retensi air sehingga pemberian albumin hanya akan memberikan efek minimal pada pasien SN dengan edema, selain dapat berpotensi menyebabkan kelebihan (overload) cairan Tujuan. Mengetahui penggunaan albumin bersama loop diuretik (furosemid) dapat menurunkan risiko terjadinya edema dibandingkan dengan penggunaan tunggal loop diuretik pada anak dengan sindrom nefrotik Metode. Penelusuran pustaka database elektronik, yaitu Pubmed, Cochrane, Proquest Hasil. Terdapat 4 penelitian yaitu 1 kohort prospektif, 2 penelitian uji klinis, serta 1 telaah sistematik mendapatkan pemberian diuretik saja aman dan efektif meningkatkan diuresis dibandingkan dengan kombinasi albumin-diuretik. Pemberian furosemid dan albumin pada pasien SN dengan edema harus sesuai kondisi klinis per pasien, pemberian terapi kombinasi dapat dipertimbangkan pada pasien yang resisten diuretik. Kesimpulan. Pemberian albumin dan furosemid bukan merupakan prosedur rutin pada setiap pasien SN dengan edema dan hipoalbuminemia. Secara statistik, terapi kombinasi diuretik dan natriuretik ini masih dianggap tidak bermakna. Sari Pediatri 2017;18(6):498-503Kata kunci: sindrom nefrotik, albumin, furosemide, diuresis Albumin and Furosemid Transfusion in Patients with Nephrotic Syndrome Children with Edema Meita Dwi Utami, Taralan TambunanBackground. The routine use of albumin for severe edema in children with NS is based on severe hypoalbuminemia decreases intravascular oncotic pressure, leading to circulatory volume depletion and subsequent sodium/water retention. Study in adults showed overfill mechanism proposes a primary renal defect in sodium excretion leading to sodium/water retention and thereby hypervolemia and edema. Albumin give a minimal effect and has potentially effect of an overload. Objective. To know beneficial effect of albumin and furosemide combination therapy in decreasing risk of edema, compared to diuretic therapy alone in children with nephrotic syndrome. Method. Literature search using electronic data base Pubmed, Cochrane, Proquest. Result. There were 4 researches consist of 1 prospective cohort, 2 clinical trials and 1 systematic review which showed that diuretic alone was save and effective in increasing diuresis compare to albumin-diuretic combination. Combination of albumin-diurestic in NS with edema should be given not routinely and can be consider in patient with diuretic resistant. Conclusion. Diuretic therapy alone is safe in pediatric patients with NS presenting with edema and hypoalbuminemia. Statistically showed that diuretic and natriuretic effect by combination albumin-furosemide was not significant. Sari Pediatri 2017;18(6):498-503

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Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Cited by 70 publications

References 26 publications

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation

Transfusi Albumin dan Furosemid pada Pasien Sindrom Nefrotik Anak dengan Edema

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