From the Guidelines
Intravenous (IV) albumin is not recommended as a routine treatment for nephrotic syndrome. While albumin infusions may temporarily increase serum albumin levels and help reduce edema in severe cases, the effect is short-lived as the administered albumin is rapidly lost in the urine due to the underlying glomerular damage. IV albumin should be reserved for specific situations such as severe hypovolemia, diuretic-resistant edema, or when preparing patients for procedures. When used, it should be administered with loop diuretics (like furosemide 40-80 mg IV) to prevent fluid overload and pulmonary edema, as suggested by the KDIGO 2021 clinical practice guideline for the management of glomerular diseases 1.
The primary treatment for nephrotic syndrome should address the underlying cause through immunosuppressive medications (such as corticosteroids, calcineurin inhibitors, or cyclophosphamide) based on the specific pathology. Supportive care includes oral diuretics, ACE inhibitors or ARBs to reduce proteinuria, statins for hyperlipidemia, and anticoagulation in high-risk patients, as outlined in the KDOQI US commentary on the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1.
Key considerations in managing nephrotic syndrome include assessing the risk of venous thrombosis and bleeding, using anticoagulant therapy when benefits outweigh risks, and monitoring international normalized ratio (INR) variability in patients with low eGFR, as discussed in the executive summary of the KDIGO 2021 guideline for the management of glomerular diseases 1.
Overall, the management of nephrotic syndrome requires a comprehensive approach that targets the underlying disease mechanism and includes supportive care to manage complications and improve patient outcomes, rather than relying solely on IV albumin therapy, which is not supported by recent high-quality evidence such as the 2021 KDIGO guideline 1.
From the FDA Drug Label
Acute Nephrosis(2) Certain patients may not respond to cyclophosphamide or steroid therapy. The steroids may even aggravate the underlying edema In this situation a loop diuretic and 100 mL Plasbumin-25 repeated daily for 7 to 10 days may be helpful in controlling the edema and the patient may then respond to steroid treatment. Situations in Which Albumin Administration is Not Warranted(2) In chronic nephrosis, infused albumin is promptly excreted by the kidneys with no relief of the chronic edema or effect on the underlying renal lesion.
Intravenous (IV) albumin therapy may be helpful in controlling edema in certain patients with acute nephrosis who do not respond to other treatments, as it can be used in combination with a loop diuretic to help manage edema 2. However, it is not warranted in cases of chronic nephrosis, as the infused albumin is promptly excreted by the kidneys with no relief of the chronic edema.
- Key points:
- IV albumin may be helpful in acute nephrosis.
- IV albumin is not warranted in chronic nephrosis.
From the Research
Effectiveness of IV Albumin Therapy for Nephrotic Syndrome
- The current evidence on the effectiveness of intravenous (IV) albumin therapy for treating nephrotic syndrome is limited and inconclusive 3, 4.
- A systematic review found that urine excretion was greater after treatment with furosemide and albumin versus furosemide, but the results for sodium excretion were inconclusive 3.
- Another review found that it is uncertain whether albumin infusion improves serum sodium, systolic blood pressure, or diastolic blood pressure in patients with nephrotic syndrome 4.
- Some studies suggest that IV albumin may be used in combination with diuretics to treat edema in nephrotic syndrome, but its effectiveness is not well established 5, 6.
Clinical Guidelines and Recommendations
- There are no established guidelines on the diagnostic workup or management of nephrotic syndrome, including the use of IV albumin therapy 5.
- Treatment of nephrotic syndrome typically includes fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors, but IV albumin is not currently recommended 5.
- Some experts suggest that IV albumin may be considered in patients with severe edema that is unresponsive to other treatments, but more research is needed to support this approach 6.
Research Gaps and Future Directions
- High-quality randomized studies with adequate sample sizes are needed to determine the effectiveness of IV albumin therapy for treating nephrotic syndrome 3, 4.
- Further research is needed to understand the role of IV albumin in treating edema in nephrotic syndrome, including its effects on urine excretion, sodium excretion, and blood pressure 3, 4.