What is the role of diuretic therapy in the treatment of pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Diuretic therapy may be beneficial, particularly in children with symptomatic edema. Loop diuretics, such as furosemide (starting at 1-2 mg/kg/day), may improve edema; their administration, however, should be handled with care because plasma volume contraction may already be present, and hypovolemic shock has been observed with overly aggressive therapy.

Metolazone may be beneficial in combination with furosemide for resistant edema. Patients must be monitored carefully on this regimen. If the child is sent home on diuretic therapy, the family must have clear guidelines about discontinuing therapy when edema is no longer present and careful communication with the family should continue.

When a patient presents with anasarca and signs of intravascular volume depletion (such as a high hematocrit, indicative of hemoconcentration), consideration should be given to administration of 25% albumin, although this is controversial. Rapid administration of albumin can result in pulmonary edema.

The author's practice has been to administer 25% albumin at a dose of 1 g/kg body weight given as a continuous infusion over 24 hours. Intravenous albumin may be particularly useful in diuretic-resistant edema and in patients with significant ascites or scrotal, penile, or labial edema. Caution should be used when administering albumin. In addition to pulmonary edema, albumin infusion can result in acute kidney injury and allergic reaction.


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