Albumin and diuretic therapy indications and effectiveness treating paediatric patients with nephrotic syndrome

Abstract

Background. Nephrotic syndrome (NS) manifests as massive proteinuria (≥3 g/l or ≥3 g in daily urine), oedema, hypoproteinaemia, hypoalbuminaemia, and hyperlipidaemia. The main treatment of NS is corticosteroids. Diuretics are prescribed for patients with significant swelling. If the patient has significant hypoalbuminaemia (<20 g/l), oliguria and severe oedema albumin infusion therapy is prescribed together with furosemide. Aim. The aim of this study was to evaluate albumin and diuretic therapy indications and effectiveness treating paediatric patients with nephrotic syndrome. Methods. A retrospective analysis was performed based on the medical histories of the paediatric patients treated in the Department of Children Diseases, Lithuanian University of Health Sciences Kaunas Clinics, in the period of 2017–2021. A total of 71 cases of nephrotic syndrome were identified. The patients who were treated with albumin and/or furosemide infusion were evaluated. Pearson χ2 criterion and MannWhitney test were used in statistical analysis. Results. Albumin infusion was administered to 66.2% of children. Albumin infusions were more often given to patients with elevated haematocrit level (p=0.033). Multiple albumin infusions were given according to the following indications: 1) hypoalbuminaemia (<20 g/l); 2) oliguria; 3) persistent oedema; 4) increased weight. A single dose of albumin was effective in 25.5% of patients, as there were no criteria for re-dosing. 66.7% of patients treated with furosemide were additionally prescribed more equal 3 times albumin infusions (p=0.002). Patients with higher daily proteinuria were more often prescribed furosemide (p=0.001) and more often required multiple doses of albumin (p=0.014). The subjects were divided into two groups by prescribed treatment: 1) steroids only, steroids and furosemide, steroids and albumin (n=32) and 2) steroids together with albumin and furosemide combination (n=39). In the first group, diuresis at hospital discharge was normal in 75% of patients and in the second group, in 94.9% of patients (p=0.017). Remission of nephrotic syndrome (based on negative urine dipstick readings or trace of protein (<1+) on three consecutive days) was equally achieved in both the first and second groups. Conclusion. Administration of combined albumin and furosemide is equally effective as treatment with separate medications. Medicaments and their combinations are prescribed strictly according to the indications.