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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 372-373
Author's Reply

National Institute of Health Research, Tehran University of Medical Sciences, No. 78, Italia Street, Keshavarz Boulevard, Tehran, Iran

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Date of Web Publication28-Feb-2012

How to cite this article:
Sepehrvand N. Author's Reply. Saudi J Kidney Dis Transpl 2012;23:372-3

How to cite this URL:
Sepehrvand N. Author's Reply. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2021 Feb 25];23:372-3. Available from: https://www.sjkdt.org/text.asp?2012/23/2/372/93185
To the Editor ,

On behalf of all the co-authors, I would like to thank Dr. Hari and Dr. Bagga for their inte­rest in our study. In the letter, they have pre­sented the results of their study, which confirm most of our findings too. Similarly, they have found that the co-administration of albumin and furosemide in patients with the NS can lead to an increase in sodium excretion and urine volume when compared with administra­tion of furosemide alone. [1],[2] It is accepted that the GFR has a strong rela­tionship with serum albumin level, as the se­rum albumin level (g/dL) is one of the six va­riables in the MDRD formula for estimating the GFR. [3] We have also mentioned that the difference between groups receiving furosemide alone and furosemide with albumin could not be explained solely by the increase in GFR in the group receiving albumin, and could suggest an improvement in furosemide's diuretic effects in addition. [2]

Since Hari et al found negative free water clearance and increased solute fluid clearance among their findings; they suggested that the increased natriuresis and diuresis occurred chiefly due to improved delivery of furose-mide to the tubules rather than intravascular volume expansion. [1] Of course, we believe that these two factors (improved drug delivery and increased intravascular volume) are not funda­mentally distinct and separate phenomena, since intravascular volume expansion leads to higher renal blood flow and probably higher GFR, which consequently can increase the de­livery of furosemide to the tubules and maxi­mize its influence.

Although some studies are against the syner-gistic effect of albumin and furosemide in increasing the diuresis, [4],[5],[6],[7] most of the recent studies are advocating their co-administration. [1],[2],[8] The studies which failed to find any poten-tiation effect of albumin infusion on the diu­retic efficacy of furosemide in patients with the NS may have some methodological errors (e.g. patient selection). For example, the study of Akcicek et al enrolled patients who were not resistant to diuretics, [4] which can justify the reason they failed to find a synergy between albumin and furosemide. Elwell et al conduc­ted a systematic review in 2003 in this regard, which concluded that the administration of albumin to enhance diuretic efficacy should be reserved for patients with severe hypoalbu-minemia. [8] We suggest that all the available studies should be critically appraised and included in a new meta-analysis to draw a final conclusion.

   References Top

1.Dharmaraj R, Hari P, Bagga A. Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome. Pediatric Nephrology 2009;24:775-82.  Back to cited text no. 1
2.Ghafari A, Mehdizadeh A, Alavi-Darazam I, Rahimi E, Kargar C, Sepehrvand N. Coadmi-nistration of albumin-furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl 2011;22:471-5.  Back to cited text no. 2
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3.Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular fil­tration rate from serum creatinine: A new pre­diction equation. Ann Intern Med 1999;130: 461-70.  Back to cited text no. 3
4.Akcicek F, Yalniz T, Basci A, Ok E, Mees EJ. Diuretic effect of frusemide in patients with nephrotic syndrome: is it potentiated by intravenous albumin? BMJ 1995;310:162-3.  Back to cited text no. 4
5.Chalasani N, Gorski JC, Horlander JC, et al. Effects of Albumin/Furosemide Mixtures on Responses to Furosemide in Hypoalbuminemic Patients. J Am Soc Nephrol 2001;12:1010-6.  Back to cited text no. 5
6.Kirchner KA, Voelker JR, Brater DC. Intra-tubular albumin blunts the response to furo-semide-A mechanism for diuretic resistance in the nephrotic syndrome. J Pharmacol Exp Ther 1990;252:1097-101.  Back to cited text no. 6
7.Sjostrom PA, Odlind BG. Effect of albumin on diuretic treatment in the nephrotic syndrome. BMJ 1995;310:1537.  Back to cited text no. 7
8.Elwell RJ, Spencer AP, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann Pharmacother 2003;37:695-700.  Back to cited text no. 8

Correspondence Address:
Nariman Sepehrvand
National Institute of Health Research, Tehran University of Medical Sciences, No. 78, Italia Street, Keshavarz Boulevard, Tehran
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