Edema in children with nephrotic syndrome and liver disease: from pathophysiology to treatment

Czech version

Authors: Ľubica Ingerová; Pavlína Berceliová; Ľudmila Podracká
Authors‘ workplace: Detská klinika LF UK a NÚDCH, Bratislava
Published in: Čes-slov Pediat 2026; 81 (5): 247-252.
Category: Pediatric Protocols in Praxis
doi: https://doi.org/10.55095/CSPediatrie2026/039

Overview

Edema is a common clinical sign in pediatric practice; however, its presence alone does not accurately reflect the patient’s intravascular volume status or guide optimal therapeutic management. Nephrotic syndrome and ascites associated with liver disease represent two typical conditions characterized by sodium and water retention, hypoalbuminemia and activation of neurohumoral pathways. Despite their similar clinical phenotype, they differ substantially in pathophysiological mechanisms of edema formation, the nature of hypoalbuminemia, alterations in hemostasis, and in the choice of diuretic therapy. In nephrotic syndrome, hypoalbuminemia primarily results from urinary albumin losses and edema formation may be driven by either the underfill or overfill mechanism. Activation of the epithelial sodium channel in the collecting duct plays a central role in sodium retention. In contrast, hypoalbuminemia associated with liver disease is predominantly caused by impaired hepatic synthetic function, while ascites develops as a consequence of portal hypertension, splanchnic vasodilation, and secondary activation of renin-angiotensin-aldosterone system (RAAS). While nephrotic syndrome is associated with a hypercoagulable state, liver failure is characterized by the concept of rebalanced hemostasis. The aim of this review is to compare the pathophysiology and management of these two conditions and to emphasize the importance of individualized treatment strategies based on assessment of the effective circulating volume.

Keywords:

Edema – Diuretics – Ascites – nephrotic syndrome – albumin – children – hemostasis – hypoalbuminemia

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