Effect of albumin on diuretic treatment in the nephrotic syndromeBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6993.1537a (Published 10 June 1995) Cite this as: BMJ 1995;310:1537
- Per A Sjostrom,
- Bo G Odlind
- Head of dialysis unit Department of Internal Medicine, Orebro Medical Centre Hospital, S-701 85 Orebro, Sweden
- Assistant professor Department of Medical Pharmacology, University of Uppsala, Uppsala, Sweden
EDITOR,—Fehmi Akcicek and colleagues have addressed the question whether albumin has an additive effect on the diuretic treatment of patients with the nephrotic syndrome.1 We have published similar results, but besides plasma volume expansion we also studied the effect of different plasma and urinary albumin concentrations.2 The same plasma volume expansion of about 20% was achieved by infusing either 40 g of albumin or 36 g of dextran 70 (Macrodex, Pharmacia AB, Sweden) in five nephrotic patients on separate study days. The plasma albumin concentration increased from 28 g/l to 33 g/l after albumin and decreased to 23 g/l after dextran. Urinary albumin excretion was unchanged after dextran but increased by 70% from 3.9 to 6.6 g/24 h after albumin. Dextran caused a considerable increase and albumin a small increase in renal blood flow (para-aminohippuric acid clearance). The glomerular filtration rate (inulin clearance) did not change after albumin or dextran infusions.
Both modes of volume expansion caused a moderate increase in the rate of urinary flow but not in the rate of excretion of sodium. The renal sensitivity to frusemide was the same after dextran and albumin. Thus, even within the pathophysiological range of urinary albumin excretion, frusemide binding to urinary albumin does not seem to impair its diuretic effect.
After 24 hours the plasma volume and plasma albumin concentration had almost returned to initial values with all protocols. Moreover, rebound effects of frusemide were seen four to 20 hours after the dose, irrespective of plasma volume expansion. Thus the additive (24 hour) diuretic and natriuretic effects of plasma volume expansion and increased plasma albumin concentration to an intravenous injection of 40 mg of frusemide in nephrotic patients were small and short lasting and thus of negligible clinical importance.
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