How to Address Low Albumin Levels in Nephrotic Syndrome
Nephrotic syndrome is a kidney disorder characterized by excessive protein loss through the urine, primarily due to damage in the glomeruli—the tiny filtering units of the kidneys. This abnormal leakage leads to a significant drop in blood albumin levels, a condition known as hypoalbuminemia. Since albumin plays a crucial role in maintaining oncotic pressure and transporting various substances in the bloodstream, its depletion can result in swelling (edema), fatigue, and increased susceptibility to infections.
Understanding the Root Cause of Low Albumin
The primary reason for low serum albumin in nephrotic syndrome is not a dietary deficiency but rather excessive urinary excretion of protein. When the kidney's filtration system becomes compromised, large amounts of albumin escape into the urine instead of being retained in circulation. Over time, this imbalance disrupts fluid regulation, leading to generalized edema—especially in the legs, face, and abdomen.
Treating the Underlying Condition
The cornerstone of managing low albumin lies in treating the underlying cause of nephrotic syndrome itself. In most cases, this involves addressing primary glomerular diseases such as minimal change disease, focal segmental glomerulosclerosis (FSGS), or membranous nephropathy. For these conditions, physicians often prescribe corticosteroids like prednisone to suppress immune-mediated inflammation within the kidneys.
Immunosuppressive agents such as cyclophosphamide, mycophenolate mofetil, or calcineurin inhibitors may also be used depending on the patient's response and specific diagnosis. As inflammation decreases, the integrity of the glomerular barrier improves, resulting in reduced proteinuria. With lower protein loss, the liver gradually restores normal albumin levels in the bloodstream—a process that may take weeks to months.
When Is Albumin Infusion Appropriate?
In certain clinical situations—particularly when patients suffer from severe edema and are unresponsive to standard diuretic therapy—intravenous human albumin infusion may be temporarily considered. This approach helps increase plasma oncotic pressure, pulling excess fluid back into the vascular space so that diuretics can work more effectively.
However, it's important to note that albumin infusions do not address the root cause of hypoalbuminemia. They offer only symptomatic relief and are typically reserved for acute, complicated cases. Routine or long-term use is discouraged due to cost, limited availability, and potential risks such as volume overload or allergic reactions.
Supportive Management Strategies
Beyond medication, supportive care plays a vital role in recovery. Patients are often advised to follow a moderate-protein, low-sodium diet to reduce kidney strain and minimize fluid retention. Some clinicians recommend vitamin D and calcium supplementation, especially if steroid therapy is prolonged, to protect bone health.
Regular monitoring of kidney function, urine protein levels, and serum albumin is essential to track progress and adjust treatment plans accordingly. Early intervention significantly improves outcomes and reduces the risk of complications such as blood clots, infections, and chronic kidney disease progression.
Conclusion: A Comprehensive Approach Works Best
Effectively managing low albumin in nephrotic syndrome requires targeting the source—kidney inflammation—not just replacing what's lost. While albumin infusions have a narrow therapeutic role, the focus should remain on immunomodulatory treatments, lifestyle adjustments, and close medical supervision. With proper care, many patients experience remission and gradual restoration of normal albumin levels over time.