Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2009 May;4(5):907-13.
doi: 10.2215/CJN.04390808. Epub 2009 Apr 30.

Treatment of severe edema in children with nephrotic syndrome with diuretics alone--a prospective study

Gaurav Kapur  1 , Rudolph P Valentini, Abubakr A Imam, Tej K Mattoo
Affiliations
Clinical Trial

Treatment of severe edema in children with nephrotic syndrome with diuretics alone--a prospective study

Gaurav Kapur et al. Clin J Am Soc Nephrol. 2009 May.

Abstract

Background and objective: Severe edema in children with nephrotic syndrome (NS) may be associated with volume contraction (VC) or volume expansion (VE). Usually, severe edema in children is treated with intravenous (IV) albumin and diuretics, which is appropriate for VC patients. However, in VE patients, this can precipitate fluid overload. The objective of this study was to evaluate treatment of severe edema in NS with diuretics alone.

Design, setting, participants, & measurements: Thirty NS patients with severe edema were enrolled in this prospective study in two phases. VC was diagnosed based on fractional excretion of sodium (FeNa) <1%. VC patients received IV albumin and furosemide. VE patients received IV furosemide and oral spironolactone. On the basis of phase 1 observations, FeNa <0.2% identified VC in 20 phase 2 patients.

Results: All phase 1 patients had FeNa <1%. Phase 1 patients when reanalyzed based on a FeNa cutoff of 0.2%; it was noted that VC patients had higher BUN, BUN/creatinine ratio, urine osmolality, and lower FeNa and urine sodium compared with VE patients. Similar results were observed in phase 2. VC patients had significantly higher renin, aldosterone, and antidiuretic hormone levels. In phase 2, 11 VE patients received diuretics alone and 9 VC patients received albumin and furosemide. There was no difference in hospital stay and weight loss in VC and VE groups after treatment.

Conclusions: FeNa is useful in distinguishing VC versus VE in NS children with severe edema. The use of diuretics alone in VE patients is safe and effective.

PubMed Disclaimer

References

    1. Fliser D, Zurbruggen I, Mutschler E, Bischoff I, Nussberger J, Franek E, Ritz E: Coadministration of albumin and furosemide in patients with the nephrotic syndrome. Kidney Int 55: 629–634, 1999 - PubMed
    1. 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 32: 198–203, 1987 - PubMed
    1. Kirchner KA, Voelker JR, Brater DC: Intratubular albumin blunts the response to furosemide. A mechanism for diuretic resistance in the nephrotic syndrome. J Pharmacol Exp Ther 252: 1097–1101, 1990 - PubMed
    1. Sjostrom PA, Odlind BG, Beermann BA, Karlberg BE: Pharmacokinetics and effects of frusemide in patients with the nephrotic syndrome. Eur J Clin Pharmacol 37: 173–180, 1989 - PubMed
    1. Haws RM, Baum M: Efficacy of albumin and diuretic therapy in children with nephrotic syndrome. Pediatrics 91: 1142–1146, 1993 - PubMed

Publication types

MeSH terms