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Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome.
J Emerg Med. 2017 Apr; 52(4):e149-e152.JE

Abstract

BACKGROUND

When the permeability of the glomerular filtration barrier increases, leading to proteinuria, nephrotic syndrome (NS) occurs. First episodes or relapses of NS can be concurrent with acute gastroenteritis (AGE) infections. This condition can cause further deterioration of the hypovolemic state, as intravascular water is lost through both AGE-related vomiting/diarrhea and NS-related fluid shifting into the interstitium. In this case report, we wish to raise the issues about the difficult management of children presenting with both NS and AGE.

CASE REPORT

We report two cases characterized by concurrence of NS and AGE. Despite our intervention, case #1 required dialysis, whereas in the case #2 we restored the patient's liquid homeostasis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: No guidelines helping general physicians in the management of children presenting with both NS and AGE are available in the literature. However, it is common for these patients to seek the first line of treatment at emergency departments. In these patients, restoring the liquid homeostasis is a challenge, but some key points can help the physicians with first-line management: 1) carefully evaluate the signs of hypovolemia (edematous state can be misleading); 2) bear in mind that-in hypovolemic, severely hypoalbuminemic (serum albumin levels < 2 g/dL) NS children-initial fluid administration should be followed by a 20% albumin infusion if oligoanuria persists; intravenous 4.5% albumin may be a valid alternative as a first-line therapy instead of crystalloid and 20% albumin; and 3) pay attention when using furosemide; it should only be administered after albumin infusion or after hypovolemia correction.

Authors+Show Affiliations

Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Pediatric Emergency Department, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon di Napoli, Napoli, Italy.Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy.Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28209267

Citation

Marzuillo, Pierluigi, et al. "Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome." The Journal of Emergency Medicine, vol. 52, no. 4, 2017, pp. e149-e152.
Marzuillo P, Guarino S, Apicella A, et al. Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome. J Emerg Med. 2017;52(4):e149-e152.
Marzuillo, P., Guarino, S., Apicella, A., Marotta, R., Tipo, V., Perrone, L., La Manna, A., & Montini, G. (2017). Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome. The Journal of Emergency Medicine, 52(4), e149-e152. https://doi.org/10.1016/j.jemermed.2016.07.089
Marzuillo P, et al. Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome. J Emerg Med. 2017;52(4):e149-e152. PubMed PMID: 28209267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of Volume Status and Appropriate Fluid Replenishment in the Setting of Nephrotic Syndrome. AU - Marzuillo,Pierluigi, AU - Guarino,Stefano, AU - Apicella,Andrea, AU - Marotta,Rosaria, AU - Tipo,Vincenzo, AU - Perrone,Laura, AU - La Manna,Angela, AU - Montini,Giovanni, Y1 - 2017/02/10/ PY - 2016/05/30/received PY - 2016/07/13/revised PY - 2016/07/19/accepted PY - 2017/2/18/pubmed PY - 2017/11/29/medline PY - 2017/2/18/entrez KW - dehydration KW - furosemide KW - hypoalbuminemia KW - hypovolemic shock KW - nephrotic syndrome SP - e149 EP - e152 JF - The Journal of emergency medicine JO - J Emerg Med VL - 52 IS - 4 N2 - BACKGROUND: When the permeability of the glomerular filtration barrier increases, leading to proteinuria, nephrotic syndrome (NS) occurs. First episodes or relapses of NS can be concurrent with acute gastroenteritis (AGE) infections. This condition can cause further deterioration of the hypovolemic state, as intravascular water is lost through both AGE-related vomiting/diarrhea and NS-related fluid shifting into the interstitium. In this case report, we wish to raise the issues about the difficult management of children presenting with both NS and AGE. CASE REPORT: We report two cases characterized by concurrence of NS and AGE. Despite our intervention, case #1 required dialysis, whereas in the case #2 we restored the patient's liquid homeostasis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: No guidelines helping general physicians in the management of children presenting with both NS and AGE are available in the literature. However, it is common for these patients to seek the first line of treatment at emergency departments. In these patients, restoring the liquid homeostasis is a challenge, but some key points can help the physicians with first-line management: 1) carefully evaluate the signs of hypovolemia (edematous state can be misleading); 2) bear in mind that-in hypovolemic, severely hypoalbuminemic (serum albumin levels < 2 g/dL) NS children-initial fluid administration should be followed by a 20% albumin infusion if oligoanuria persists; intravenous 4.5% albumin may be a valid alternative as a first-line therapy instead of crystalloid and 20% albumin; and 3) pay attention when using furosemide; it should only be administered after albumin infusion or after hypovolemia correction. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/28209267/Assessment_of_Volume_Status_and_Appropriate_Fluid_Replenishment_in_the_Setting_of_Nephrotic_Syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(16)30540-6 DB - PRIME DP - Unbound Medicine ER -