Table 1.
Clinical studies assessing use of furosemide and albumin in patients with nephrotic syndrome.
| Study | Design | No. of Patients | Mean Age (Year) | Disease | Serum Albumin (g/dL) | Serum Cr (mg/dL) | Furosemide (Fu)-Human Albumin (A) Dose | Results * |
|---|---|---|---|---|---|---|---|---|
| Adults | ||||||||
| Eadington et al. [7] | Observational | 5 | 55.4 | Nephrotic syndrome (NS) | 1.5–2.6 | 2.86 | NR | Significant weight loss at 1 week |
| Akcicek et al. [8] | RCT, cross-over | 8 | NR | Nephrotic syndrome (NS) | 1.1–2.2 | 1.2–2.4 | Fu: 220 mg total (60 mg bolus + 40 mg/h × 4 h) A: 0.5 mg/kg × 4 h |
No increased efficacy of combined F-A compared to F alone |
| Fliser et al. [9] | RCT, cross-over | 9 | 48 ± 4 | NS with biopsy-proven renal disease | 3.0 +/− 2.3 | All < 1.3 except in one patient (NR) | Fu: 60 mg A: 200 mL of 20% soln. |
Increase in 8 h urinary volume, UNa, UCl, and Ualb in F-A when compared to either alone |
| Na et al. [10] | RCT, cross-over | 7 | 41 ± 23 | NS with biopsy-proven renal disease | 1.7 +/− 0.2 | 1.6 ± 0.8 | Fu: 160 mg A: 100 mL of 20% soln. |
Combined F-A increased diuresis but not natriuresis |
| Ghafari et al. [11] | RCT, cross-over | 10 | NR | NS | NR (<3.5) | NR (stated “normal kidney function”) | Fu: 2 mg/kg/TDS A: 0.5 g/kg/TDS |
Increase in 24 h urine volume, FeNa, and urine sodium in F-A when compared to either alone |
| Phakdeekitcharoen et al. [12] | RCT, cross-over | 24 | 66.4 ± 12.8 | Hypoalbu-minemia and CKD (GFR <60 mL/min) | 3.0 +/− 0.3 | 2.2 ± 0.8 | Fu: 40 mg A: 10 g of 20% soln. |
Combined F-A had superior short-term (<6 h) diuretic and natriuretic effect compared to F alone |
| Children | ||||||||
| Weiss et al. [13] | Cohort | 24 | NA | NS | 1.8 ± 0.3 | NA | Fu:1–2 mg/kg A: ~1 g/kg |
Reduction in body weight (not compared with furosemide or albumin alone) |
| Haws and Baum [14] | Retrospective | 21 | 5.5 ± 0.5 | Primary glomeular diseases | 1.6 ± 0.2 | 0.7 ± 0.1 | Fu:1.5 mg/kg A: 25% |
Body weight loss of 1.2% ± 0.2% per infusion |
| Bircan et al. [15] | Prospective | 14 | 6.57 ± 2.25 | Minimal change disease | 1.74 | NR | Fu: 2 mg/kg A: 0.5 g/kg 20% salt-poor soln |
Reduction in body wt and abdominal circumference |
| Dharmarajy et al. [16] | Randomized cross-over trial | 16 | 3–18 | NS | 1.3 g/dL | 0.6 mg/dL | Fu: 1 mg/kg followed by 0.3 mg/kg for 24 h A: 1 g/kg 20% soln |
Improvement in both diuresis and natriuresis |
RCT—randomized control trial; NA—not available; NR—not reported; TDS—total dissolved solids; * denotes statistically significant findings (p < 0.05).