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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 371-372
Co-administration of albumin and furosemide in patients with the nephrotic syndrome


Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication28-Feb-2012
 

How to cite this article:
Hari P, Bagga A. Co-administration of albumin and furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl 2012;23:371-2

How to cite this URL:
Hari P, Bagga A. Co-administration of albumin and furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2014 Nov 28];23:371-2. Available from: http://www.sjkdt.org/text.asp?2012/23/2/371/93184
To the Editor,

We read with interest the article by Gafari et al on co-administration of albumin and furo-semide in adults with the nephrotic syndrome (NS). [1] Impaired response to loop diuretics in the NS could be due to decreased delivery of furosemide into the tubular lumen, hypovo-lemia, and reduced glomerular filtration rate (GFR). Gafari et al have demonstrated higher urine volumes and urinary sodium excretion when furosemide was co-administered with albumin as compared to when albumin or furo-semide was administered alone. They also showed increased GFR with albumin infusion. While several studies have demonstrated that albumin infusion can enhance diuresis in the NS, [2],[3],[4] others have failed to do so. [5],[6] We, in a randomized controlled cross-over trial, have shown that co-administration of human albu­min with furosemide infusion caused a further increase in urine volume, and sodium and chloride excretion as compared to furosemide infusion alone in children with the NS. [7] We also found that high doses of furosemide alone, given as infusion, improved diuresis and natriuresis from the baseline which suggests that poor furosemide delivery to the tubules can be partly overcome by administering high doses of furosemide as infusion.

We measured urine osmolality and calculated osmolal clearance and free water clearance in our patients. Co-administration of albumin with furosemide increased osmolal clearance [1600 mL/day (95% CI 916-4140)] as compared to furosemide administered alone [880 mL/day (95% CI 510-2105)], but there was a reduction in free water clearance. The free water clea­rance was negative in patients who received albumin and furosemide infusion (-190 mL/day) and those who were given furosemide infusion alone (-162 mL/day). Negative free water clearance and increased solute fluid clearance suggests that the levels of anti-diuretic hor­mone were elevated and that our patients were in a state of hypovolemia. An elevated blood urea/creatinine ratio, which is an indicator of low intravascular volume, further substantiated this finding. Our results suggested that admi­nistration of human albumin did not signifi­cantly correct hypovolemia. It is possible that intravascular expansion did occur in these pa­tients but these patients reverted back to hypo-volemia due to profound natriuresis and diu­resis. We speculated that natriuresis and diu­resis occurred chiefly due to potentiation of effects of furosemide following improved drug delivery to the tubules rather than intravascular volume expansion.

 
   References Top

1.Ghafari A, Mehdizadeh A, Alavi-Darazam I, Rahimi E, Kargar C, Sepehrvand N. Co-admi­nistration of albumin-furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl 2011;22:471-5.  Back to cited text no. 1
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2.Davison AM, Lambie AT, Verth AH, Cash JD. Salt poor human albumin in management of nephrotic syndrome. Br Med J 1974;16:481-4.  Back to cited text no. 2
    
3.Eadington DW, Plant WD, Winney RJ. Albumin in the nephrotic syndrome. Br Med J 1995;310: 1333.  Back to cited text no. 3
    
4.Fliser D, Zurbruggen D. Coadministration of albumin and frusemide in patients with neph-rotic syndrome. Kidney Int 1999;55:629-33.  Back to cited text no. 4
    
5.Akcicek F. Diuretic effects of frusemide in pa­tients with nephrotic is it potentiated by intra­venous albumin? Br Med J 1995;310:102-3.  Back to cited text no. 5
    
6.Han JS, Na KY. Does albumin preinfusion po­tentiates diuretic action of frusemide in pa­tients with nephrotic syndrome. J Korean Med Sci 2001;16:448-54.  Back to cited text no. 6
    
7.Dharmaraj R, Hari P, Bagga A. Randomized cross-over trial comparing albumin and fruse-mide infusions in nephrotic syndrome. Pediatr Nephrol 2009;24:775-82.  Back to cited text no. 7
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Correspondence Address:
Pankaj Hari
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
India
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PMID: 22382243

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