The indiscriminate use of albumin in children with a first episode of nephrotic syndrome is not recommended.
In children presenting with a first episode of nephrotic syndrome, albumin infusions (followed by intravenous boluses of furosemide) should be exclusively limited to hypovolemic patients. While in these children albumin infusions can increase intravascular volume, thus improving renal haemodynamics and increasing diuresis, in hypervolemic cases the opposite occurs and hypovolemia can be exacerbated, contributing to hypertension and the risk of causing or worsening pulmonary oedema. Clinical symptoms (hypotension, tachycardia, abdominal pain, headache or dizziness, drowsiness, delayed capillary refill, muscle cramps) and a marked reduction in the fractional excretion of sodium (FENa <0.2) are the evaluation parameters to use in the diagnosis of hypovolemia.
1. Pasini A, Aceto G, Ammenti A, Ardissino G, Azzolina V, Bettinelli A, Cama E, Cantatore S, Crisafi A, Conti G, D'Agostino M, Dozza A, Edefonti A, Fede C, Groppali E, Gualeni C, Lavacchini A, Lepore M, Maringhini S, Mariotti P, Materassi M, Mencarelli F, Messina G, Negri A, Piepoli M, Ravaglia F, Simoni A, Spagnoletta L, Montini G; NefroKid Study Group. Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality. 2015 Jan; 30(1): 91-101.
2. Melissa A. Cadnapaphornchai & Oleksandra Tkachenko & Dmitry Shchekochikhin & Robert W. Schrier. The nephrotic syndrome: pathogenesis and treatment of edema formation and secondary complications. Pediatr Nephrol (2014) Jul; 29 (7): 1159–1167.
3. Kapur G, Valentini RP, Imam AA, Mattoo TK. Treatment of severe edema in children with nephrotic syndrome with diuretics alone—a prospective study. Clin J Am Soc Nephrol (2009) May; 4 (5): 907–13
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