Experience with the use of human albumin in renal patients at the Kenyatta National Hospital

Abstract

In a 20-month period (May 1990 to December 1991), 34 patients with diuretic resistant oedema due to nephrotic syndrome, 4 patients with severe hypotension during haemodialysis and 3 patients with refractory ascites on chronic haemodialysis were treated with infusion of highly purified human placental albumin (HPHPA). In the 34 patients with resistant oedema due to nephrotic syndrome, infusion with HPHPA resulted in prompt diuresis, weight loss and normalisation of the blood urea nitrogen. These effects were maintained for three weeks after stopping the daily infusions, but started reverting to the pretreatment levels thereafter. Twelve of the 34 patients in whom prior attempts or renal biopsy had failed because of gross oedema, had this done following the resolution of oedema. In the 4 patients with severe hypotension (blood pressure, Systolic/Diastolic mmHg; Mean SD +/- 792 +/- 50 +/- 9) during haemodialysis the blood pressure rose to 135 +/- 11/87 +/- 8 following a rapid infusion of 100mls of 25% HPHPA and remained at that level during the course of haemodialysis. Three patients on chronic haemodialysis with refractory ascites were treated with four sessions of large-volume paracentesis. At each session they were infused with 200mls of 25% HPHPA over one hour. No clinically overt haemodynamic disturbance was noted thereafter and the patients were relieved of abdominal discomfort and respiratory difficulties for a period varying between 4 and 11 weeks before the ascites reaccumulated.