Purpose of Albumin Infusion in Nephrotic Syndrome
Understanding Albumin Replacement in Nephrotic Syndrome
One of the key clinical challenges in managing nephrotic syndrome is severe hypoalbuminemia—a condition where blood albumin levels drop significantly, often below 30 g/L. In more critical cases, levels may fall as low as 10–20 g/L. This deficiency directly impacts the body's ability to maintain proper fluid balance, leading to widespread edema and compromised organ perfusion.
Why Is Albumin Infused in These Patients?
The primary goal of intravenous albumin infusion is to restore plasma oncotic pressure—the force that keeps fluid within blood vessels. When albumin levels are too low, fluid leaks into surrounding tissues, causing swelling in the legs, abdomen, and even around vital organs like the lungs and brain. By replenishing albumin, clinicians aim to:
- Improve plasma colloid osmotic pressure
- Reduce tissue edema
- Enhance circulation to essential organs such as the kidneys and heart
- Support overall hemodynamic stability
A Supportive, Not Curative, Treatment Approach
While albumin infusions provide immediate symptomatic relief, they do not address the root cause of protein loss. Nephrotic syndrome is characterized by excessive proteinuria—large amounts of protein leaking into the urine due to damaged glomeruli in the kidneys. Therefore, albumin replacement is considered a palliative or adjunct therapy, useful during acute phases but insufficient on its own for long-term recovery.
The Importance of Targeting the Underlying Disease
To achieve lasting improvement, treatment must focus on the primary renal pathology. This includes using immunosuppressive drugs (like corticosteroids or cyclophosphamide), managing blood pressure with ACE inhibitors or ARBs, and reducing protein excretion. Only by controlling the disease process can patients gradually rebuild their serum albumin levels naturally and minimize dependency on transfusions.
When Is Albumin Therapy Recommended?
Clinicians typically reserve albumin infusions for specific scenarios, such as:
- Severe edema unresponsive to diuretics
- Preoperative preparation in malnourished patients
- Acute complications like hypovolemic shock or pleural effusion
In these cases, combining albumin with loop diuretics can enhance fluid removal while maintaining vascular volume.
Balancing Benefits and Risks
Despite its benefits, albumin infusion isn't risk-free. Potential complications include volume overload, increased blood pressure, and even thrombotic events. Moreover, frequent use can be costly and does not improve long-term outcomes if the underlying kidney disease remains untreated.
Towards Comprehensive Patient Management
Effective care for nephrotic syndrome requires a multifaceted strategy: nutritional support, medication adherence, regular monitoring of kidney function, and patient education. While albumin plays a valuable role in stabilizing critically low protein levels, it should always be part of a broader therapeutic plan aimed at healing the kidneys and preventing relapse.