Combined furosemide and human albumin treatment for diuretic-resistant edema.
OBJECTIVE
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.


METHODS
Clinical literature was accessed through MEDLINE (1966-May 2002). Key search terms included furosemide, albumin, human albumin solution, nephrotic syndrome, and cirrhosis.


RESULTS
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.


CONCLUSIONS
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.
Elwell
Rowland J
RJ
Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208-3492, USA. elwellr@acp.edu
Spencer
Ann P
AP
Eisele
George
G
D000418:Albumins / Q000627:therapeutic use*; D001201:Ascites / Q000188:drug therapy; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004487:Edema / Q000188:drug therapy*; D005665:Furosemide / Q000627:therapeutic use*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy; D009404:Nephrotic Syndrome / Q000188:drug therapy
D000418:Albumins; D004232:Diuretics; D005665:Furosemide