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Nature Reviews. Cardiology Mar 2013Oedema is one of the fundamental features of heart failure, but the pathophysiology of oedema varies. Patients present along a spectrum ranging from acute pulmonary... (Review)
Review
Oedema is one of the fundamental features of heart failure, but the pathophysiology of oedema varies. Patients present along a spectrum ranging from acute pulmonary oedema to gross fluid retention and peripheral oedema (anasarca). In patients with pure pulmonary oedema, the problem is one of acute haemodynamic derangement; the patient does not have excess fluid, but pulmonary venous pressure rises such that the rate of fluid transudation into the interstitium of the lung exceeds the capacity of the pulmonary lymphatics to drain away the fluid. Conversely, in patients with peripheral oedema, the problem is one of fluid retention. Understanding the causes of oedema will enable straightforward, correct management of the condition. For patients with acute pulmonary oedema, vasodilatation is important to reduce cardiac filling pressures. For patients with fluid retention, removing the fluid, using either diuretics or mechanical means, is the most important consideration.
Topics: Aged; Capillary Permeability; Edema; Female; Heart Failure; Hemodynamics; Humans; Male; Prognosis; Pulmonary Edema; Risk Factors; Water-Electrolyte Balance
PubMed: 23319101
DOI: 10.1038/nrcardio.2012.191 -
Pediatrics in Review Mar 2021
Topics: Adolescent; Edema; Humans
PubMed: 33648995
DOI: 10.1542/pir.2020-0003 -
Pediatric Nephrology (Berlin, Germany) Aug 2022Edema is one of the cardinal clinical features of nephrotic syndrome (NS). It may vary from mild periorbital edema to severe generalized edema (anasarca). In patients... (Review)
Review
BACKGROUND
Edema is one of the cardinal clinical features of nephrotic syndrome (NS). It may vary from mild periorbital edema to severe generalized edema (anasarca). In patients where edema does not improve with prednisone therapy, the most common supportive medications are diuretics and albumin. However, due to the complex pathophysiology of edema formation in NS patients resulting in intravascular normovolemia or hypovolemia, optimal therapy for edema is still debated. We conducted a systematic review with the objective of evaluating the change in urine volume and urine sodium excretion after treatment with furosemide only versus furosemide with albumin in edematous patients with NS.
OBJECTIVES
(1) To evaluate efficacy of furosemide alone versus furosemide with albumin in the treatment of nephrotic edema in adults and children. (2) To compare the harms and benefits of different doses of furosemide for treating nephrotic edema.
SEARCH METHODS
The search included all randomized or quasi-randomized controlled trials in English and French using MEDLINE, Embase, and CENTRAL Trials Registry of the Cochrane Collaboration using the Ovid interface.
CLINICALTRIALS
gov and the International Clinical Trials Registry Platform were also searched.
SELECTION CRITERIA
We included all RCTs and randomized cross-over studies in which furosemide and furosemide plus albumin are used in the treatment of children or adults with nephrotic edema. We excluded patients with hypoalbuminemia of non-renal origin and severe chronic kidney disease (CKD) with a glomerular filtration rate below 30 ml/min/1.74 m and patients with congenital NS.
DATA COLLECTION AND ANALYSIS
All abstracts were independently assessed by at least two authors to determine which studies met the inclusion criteria. Information on study design, methodology, and outcome data (urine volume, urine sodium excretion, adverse effects) from each identified study was entered into a separate data sheet. The differences in outcomes between the types of therapy were expressed as standardized mean difference (SMD) with 95% confidence intervals (CI).
RESULTS
The search yielded 525 records, and after screening, five studies were included in the systematic review and four of those studies in the meta-analysis. One study had high risk of bias and the remaining three studies were deemed to have some concerns. Urine excretion was greater after treatment with furosemide and albumin versus furosemide (SMD 0.85, 95% CI = 0.33 to 1.38). Results for sodium excretion were inconclusive (SMD 0.37, 95%CI = - 0.28 to 1.02).
AUTHORS' CONCLUSIONS
The current evidence is not sufficient to make definitive conclusions about the role of albumin in treating nephrotic edema. High-quality randomized studies with adequate samples sizes are needed. Including an assessment of intravascular volume status may be helpful.
TRIAL REGISTRATION
Prospero: CRD4201808979. https://www.crd.york.ac.uk/PROSPERO A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Adult; Albumins; Child; Edema; Furosemide; Humans; Nephrotic Syndrome; Sodium
PubMed: 35239032
DOI: 10.1007/s00467-021-05358-4 -
Pediatric Rheumatology Online Journal Aug 2021Juvenile Dermatomyositis (JDM) is an autoimmune disease that typically presents with classic skin rashes and proximal muscle weakness. Anasarca is a rare manifestation...
BACKGROUND
Juvenile Dermatomyositis (JDM) is an autoimmune disease that typically presents with classic skin rashes and proximal muscle weakness. Anasarca is a rare manifestation of this disease and is associated with a more severe and refractory course, requiring increased immunosuppression. Early recognition of this atypical presentation of JDM may lead to earlier treatment and better outcomes.
CASE PRESENTATION
We present two female patients, ages 11 years old and 4 years old, who presented to the ED with anasarca and were subsequently diagnosed with JDM. Both patients required ICU-level care and significant immunosuppression, including prolonged courses of IV methylprednisolone, IVIG, and Rituximab.
CONCLUSIONS
Anasarca is a rare presentation of Juvenile Dermatomyositis, but it is important for clinicians to recognize this manifestation of the disease. Early recognition and treatment will lead to better outcomes in these children and hopefully decrease the need for prolonged hospitalization and ICU level care.
Topics: Child; Child, Preschool; Dermatomyositis; Edema; Female; Humans; Skin Diseases
PubMed: 34389019
DOI: 10.1186/s12969-021-00604-3 -
Transplant International : Official... 2022
Topics: Edema; Humans; Kidney Transplantation; Lymphadenopathy
PubMed: 35368636
DOI: 10.3389/ti.2022.10148 -
Asian Cardiovascular & Thoracic Annals Feb 2021
Topics: Atrial Appendage; Edema; Hamartoma; Heart Atria; Humans
PubMed: 33023301
DOI: 10.1177/0218492320966146 -
BMJ Case Reports May 2024A woman in her 70s presented with anasarca and exertional dyspnoea. Investigation showed severe hypoalbuminaemia with no urinary or gastrointestinal protein losses. CT...
A woman in her 70s presented with anasarca and exertional dyspnoea. Investigation showed severe hypoalbuminaemia with no urinary or gastrointestinal protein losses. CT thorax reported lung consolidations, and transbronchial lung biopsy demonstrated organising pneumonia. Autoimmune myositis serology was positive for anti-Jo-1, anti-Ro-52, and anti-PM/Scl-100 antibodies. She was diagnosed with anti-synthetase syndrome with organising pneumonia. She was treated with oral prednisolone and oral mycophenolate mofetil with a good clinical response.
Topics: Humans; Female; Myositis; Aged; Edema; Prednisolone; Mycophenolic Acid; Tomography, X-Ray Computed; Pneumonia; Dyspnea
PubMed: 38749521
DOI: 10.1136/bcr-2023-258359 -
Hematology/oncology Clinics of North... Feb 2018TAFRO syndrome is a newly recognized variant of idiopathic multicentric Castleman disease (iMCD) that involves a constellation of syndromes: thrombocytopenia (T),... (Review)
Review
TAFRO syndrome is a newly recognized variant of idiopathic multicentric Castleman disease (iMCD) that involves a constellation of syndromes: thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (R), and organomegaly (O). Thrombocytopenia and severe anasarca accompanied by relatively low serum immunoglobulin levels are characteristic clinical findings of TAFRO syndrome that are not present in iMCD-not otherwise specified (iMCD-NOS). Lymph node biopsy is recommended to exclude other diseases and to diagnose TAFRO syndrome, which reveals characteristic histopathological findings similar to hyaline vascular-type CD. TAFRO syndrome follows a more aggressive course, compared with iMCD-NOS, and there is no standard treatment.
Topics: Castleman Disease; Edema; Fever; Humans; Syndrome; Thrombocytopenia
PubMed: 29157612
DOI: 10.1016/j.hoc.2017.09.009 -
Annales de Pathologie Jan 2023The term "Castleman disease" covers a variety of entities that have very different clinical, biological, pathological and physiopathological features. In this issue, we... (Review)
Review
The term "Castleman disease" covers a variety of entities that have very different clinical, biological, pathological and physiopathological features. In this issue, we review the characteristics of the unicentric Castleman disease, of the HHV8 associated multicentric Castleman disease and the idiopathic multicentric Castleman disease associated or not with TAFRO syndrome ("thrombocytopenia, anasarca, fever, reticulin myelofibrosis and/or renal insufficiency, organomegaly"). We detail the differential diagnostics of these entities.
Topics: Humans; Castleman Disease; Renal Insufficiency; Thrombocytopenia; Edema
PubMed: 36192235
DOI: 10.1016/j.annpat.2022.07.013 -
Clinical Pediatrics Jun 2014
Topics: Anemia; Anemia, Iron-Deficiency; Diagnosis, Differential; Edema; Female; Humans; Hypoalbuminemia; Infant; Protein-Losing Enteropathies
PubMed: 24647692
DOI: 10.1177/0009922814526990