Comparison of Manitol and Albumin Treatment in Diuretic Resistant Edema in Children with Nephrotic Syndrome Referred to Ali Asghar Children Hospital in 2002

Nephrotic syndrome is an important disease in children and the diagnosis and treatment of its complications is important. Edema is one of these complications which is more common and severe in children and has different treatment in comparison with adults. Treatment of edema in children contains protocols that increase intravascular volume and decrease sodium reabsorption in all parts of nephron especially proximal tubule and aldostrone inhibitors, whereas sodium channel blockers in distal nephron(like amiloride) are used in adults. Albumin is an appropriate drug for the treatment of edema in children, although it has a few side effects such as expensiveness, intensifying interestitium nephritis and reducing furosmide effect. Therefore, nowadays, it has been tried to use drugs that have albumin advantages but no side effects(like manitol) for the treatment of edema. Thus, it was decided to use manitol and compare its effects with albumin on weight loss and reducing edema. The patients of the present study took albumin and manitol patient by patient. Weight loss(first and last weight) which was important for us was remarkable in both groups(Pv<0.001). There was no significant difference between these two groups of patients on manitol or albumin protocol regarding weight loss(Pv>0.005). Also, this weight difference did not have any relation with the amount of serum albumin in these two groups. Complications did not show any remarkable difference in both groups. Complications were evident in 16% of patients with manitol and 17% of other patients with albumin protocol. Complications in manitol protocol were hypokalemia and hypertension whereas they were hypertension and dehydration in albumin protocol. 15.8% of patients treated with manitol did not respond to this drug. This absence of response was seen in 30% of patients with albumin protocol. All the patients who were under manitol treatment and did not respond to it had MCD.