Combined Furosemide and Human Albumin Treatment for Diuretic-Resistant Edema

  • Rowland J Elwell
    Rowland J Elwell PharmD, Nephrology Fellow, Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY
  • Ann P Spencer
    Anne P Spencer PharmD, Assistant Professor, Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
  • George Eisele
    George Eisele MD, Associate Professor, Division of Nephrology, Department of Medicine, Albany Medical College

説明

<jats:sec><jats:title>OBJECTIVE:</jats:title><jats:p> To evaluate the clinical usefulness of combined furosemide and human albumin for the treatment of diuretic-resistant edema in patients with nephrotic syndrome and cirrhosis. </jats:p></jats:sec><jats:sec><jats:title>DATA SOURCES:</jats:title><jats:p> Clinical literature was accessed through MEDLINE (1966–May 2002). Key search terms included furosemide, albumin, human albumin solution, nephrotic syndrome, and cirrhosis. </jats:p></jats:sec><jats:sec><jats:title>DATA SYNTHESIS:</jats:title><jats:p> Hypoalbuminemia, edema, and ascites are often manifestations of nephrotic syndrome and cirrhosis of the liver. Many patients with these conditions are resistant to the effects of diuretics. The combination of furosemide and human albumin solution is occasionally used in these patients. An evaluation of published studies focusing on combined furosemide and albumin in the management of nephrotic syndrome and cirrhosis was conducted. </jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS:</jats:title><jats:p> Published studies report conflicting results regarding the efficacy of combined furosemide and albumin. Although it is difficult to generate firm conclusions, it appears the combination may provide clinical benefits for select patients. Given these findings, we believe that the addition of albumin to enhance diuretic efficacy should be reserved for patients with recalcitrant edema or ascites in whom diuretic doses have been maximized and those with severe hypoalbuminemia. </jats:p></jats:sec>

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