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Albumin Furosemide Co-Infusion Nephrotic — ESENeph MCQ

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HardGlomerulonephritisAlbumin Furosemide Co-Infusion NephroticESENeph

A 50-year-old man with CKD G4 and heavy proteinuria (5 g/day) from FSGS has massive oedema. His albumin is 12 g/L. IV Furosemide 250 mg has been given but urine output remains low. His nephrologist considers co-infusing IV albumin with IV Furosemide. What is the rationale?

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Correct answer: A — Co-infusion of albumin increases intravascular volume and Furosemide delivery to the kidney; albumin binds Furosemide, improving its delivery to the proximal tubule for secretion – though evidence for sustained benefit is limited

The rationale for albumin-Furosemide co-infusion is twofold: (1) albumin expands intravascular volume, improving renal perfusion in patients with hypoalbuminaemic intravascular depletion; (2) Furosemide is highly protein-bound and its delivery to the proximal tubule (where it is secreted into the lumen) may be enhanced by albumin binding. However, RCT evidence for sustained benefit is limited (Fliser et al 1999, Chalasani et al 2001 showed transient improvement only). KDIGO 2021 acknowledges this as a clinical option but notes the weak evidence base.

Reference: KDIGO 2021 – GN Guideline (Oedema Management); Fliser et al 1999