| |
|
|
| Year : 2012 | Volume
: 23
| Issue : 2 | Page : 372-373 |
|
| Author's Reply |
|
|
Nariman Sepehrvand
National Institute of Health Research, Tehran University of Medical Sciences, No. 78, Italia Street, Keshavarz Boulevard, Tehran, Iran
Click here for correspondence address and email
| Date of Web Publication | 28-Feb-2012 |
|
|
 |
|
How to cite this article:
Sepehrvand N. Author's Reply. Saudi J Kidney Dis Transpl 2012;23:372-3 |
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 | |  |
| 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. 
[PUBMED] [FULLTEXT] |
| 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.
[PUBMED]  |
| 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.
[PUBMED] [FULLTEXT] |
| 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.
[PUBMED] [FULLTEXT] |
| 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.
|
| 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.
[PUBMED] [FULLTEXT] |
| 7. | Sjostrom PA, Odlind BG. Effect of albumin on diuretic treatment in the nephrotic syndrome. BMJ 1995;310:1537.
|
| 8. | Elwell RJ, Spencer AP, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann Pharmacother 2003;37:695-700.
[PUBMED] [FULLTEXT] |
Correspondence Address:
Nariman Sepehrvand
National Institute of Health Research, Tehran University of Medical Sciences, No. 78, Italia Street, Keshavarz Boulevard, Tehran
Iran
  | Check |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Article Access Statistics | | | Viewed | 1313 | | | Printed | 34 | | | Emailed | 0 | | | PDF Downloaded | 250 | | | Comments | [Add] | | |
|
|
