A Crossover Comparative Study to Assess Efficacy of 5% vs. 20% Albumin in the Treatment of Anasarca in Children with Idiopathic Nephrotic Syndrome

  • Ajoy Kumar Garg Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India
  • Suprita Kalra Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India
  • Ashutosh Kumar Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India
  • Madhuri Kanitkar 2DCIDS Medical, New Delhi, India
Keywords: albumin; diuretic; nephrotic syndrome; oedema; urine output

Abstract

Introduction: Co-administration of albumin and furosemide has shown better response than furosemide alone in managing anasarca among children with nephrotic syndrome. There are different concentrations of albumin available. The aim of this study was to compare diuretic response to co-administration of either 5% or 20% albumin with furosemide in these children.

Methods: It was a crossover randomised trial conducted on children with nephrotic syndrome with moderate to severe oedema at a tertiary care centre. They were  randomised to two groups; Group A (n = 14) received 5% albumin along with furosemide in midway followed by 20% albumin after washout period of 48 hrs and group B (n = 10) received albumin vice versa. Baseline and post therapy vitals, fluid intake, urine output and biochemistry were noted. Primary outcomes were increase in urine output and reduction in weight following co-administration of albumin with furosemide. For analysis of primary outcomes, two interventional arms were formed; group I (5% Albumin co-administered with furosemide) and group II (20% albumin co-administered with furosemide).

Results: Total children were 24 in each arm i.e. group I and II. Eighteen (75%) were males. Mean (range) age at enrolment and duration of illness were 55.3 (15 - 144) and 18.6 (1 - 120) months respectively. Mean difference (SD) in urine output were 1.52 (1.11) and 1.66 (0.95) ml/kg/hr (p = 0.12) and mean percentage weight loss were 2.25% (2.12) and 3.68% (3.84) in group I and II respectively (p = 0.64). On further comparing, urine output was significantly better when 5% albumin was co-administered with furosemide during first period than in second period.

Conclusions: Co-administration of either 5% or 20% albumin with furosemide is equally safe and effective in increasing urine output in children with anasarca.

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Author Biographies

Ajoy Kumar Garg, Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India

Wg Cdr (Dr) Ajoy Kumar Garg                                      

Consultant Paediatrics & Neonatology

Army Hospital (R&R),New Delhi

Suprita Kalra, Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India

Lt Col(Dr) Suprita Kalra

Consultant Paediatrics & Paediatric Nephrology

 Army Hospital(R&R) New Delhi

Ashutosh Kumar, Department of Paediatrics, Army Hospital (Research and Referral), New Delhi, India

Lt Col (Dr) Ashutosh Kumar

Consultant Paediatrics  & Neonatology

Army Hospital (R&R)

Madhuri Kanitkar, 2DCIDS Medical, New Delhi, India

Lt Gen (Dr)Madhuri Kanitkar, AVSM VSM

Senior Consultant Paediatrics & Paediatric Nephrology

DCIDS Medical, New Delhi

Published
2020-12-15
How to Cite
Garg, A., Kalra, S., Kumar, A., & Kanitkar, M. (2020). A Crossover Comparative Study to Assess Efficacy of 5% vs. 20% Albumin in the Treatment of Anasarca in Children with Idiopathic Nephrotic Syndrome. Journal of Nepal Paediatric Society, 40(3), 157-163. https://doi.org/10.3126/jnps.v40i3.29110
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Original Articles