Albumin and Furosemide versus Mannitol and Furosemide in the Treatment of Diuretic Resistant Oedema in Childhood Nephrotic Syndrome

Abstract

Background: To treat resistant oedema in childhood nephrotic syndrome is a therapeutic dilemma. This study was carried out to compare the efficacy of mannitol & furosemide with that of albumin & furosemide in the treatment of diuretic resistant oedema in childhood nephrotic syndrome. Methodology: Forty children with “resistant oedema” due to idiopathic nephrotic syndrome at Paediatric Nephrology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) from September 2006 to April 2008 were enrolled in this descriptive cross sectional study. `Resistant oedema` was considered based on failure to achieve therapeutic response to diuretics or a weight loss of <1% body weight daily. All nephrotic syndrome patients with anasarca, age 1 year to 15 years of both sexes were hospitalized and were managed with fluid restriction, salt restriction and bed rest. Beside these 2 mg/kg/day oral furosemide or combination of furosemide and spironolactone, were given for 3 days to achieve desired diuresis. Those patients who did not get response were divided into two groups (Group-A, Group-B) in consecutive fashion. The Group- A study population, was with intravenous mannitol 0.5-1 gm/kg/day in single daily dose over 1-2 hrs followed by intravenous furosemide 1 mg/kg/day for 5 days. The Group-B study population was with intravenous albumin, 0.5 – 1 gm/ kg /day in single daily dose over 1-2 hrs followed by intravenous furosemide 1 mg/kg/day in every alternate day, total 3 doses. Efficacy of both groups of drugs was observed day to day by recording the follow-up chart. Results: Efficacy of treatment was evaluated by measuring weight loss and increment of urine volume. Much more increment of urine volume was occurred after albuminfurosemide infusion (1383±949.45ml vs 139.17±88.84ml) than in mannitol-furosemide infusion (928.13±359.61ml vs 151.88±67.15ml). But the difference between the two groups was not statistically significant. Body weight was reduced 13.74% in Mannitolfurosemide group. All other parameters like abdominal girth and complications of oedema reduction were similar with albumin & furosemide group. Conclusion: It is concluded that response to mannitol-furosemide combination is as effective as albumin with furosemide in the treatment of diuretic resistant oedema in children with nephrotic syndrome. However, new combination is less costly and may be more useful in our society. DOI: http://dx.doi.org/10.3329/bjch.v38i2.21139 Bangladesh J Child Health 2014; VOL 38 (2) : 68-73