A Study of the Mechanisms of Edema Formation in Patients with the Nephrotic Syndrome 1

Eder, Howard A.; Lauson, Henry D.; Chinard, Francis P.; Greif, Roger L.; Cotzias, George C.; Slyke, Donald D. Van

doi:10.1172/jci102935

Cited by 47 publications

(13 citation statements)

References 39 publications

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“…The effects of albumin infusions on serum albumin concentration, proteinuria and edema were similar to those generally noted by previous investigators (28)(29)(30)(31)(32) …”

Section: Effects Of Albumin Infusionssupporting

confidence: 87%

Effects of Infusions of Serum Albumin on Serum Lipids and Lipoproteins in Nephrosis

Baxter¹,

Goodman²,

Allen³

1961

J. Clin. Invest.

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Serum lipid and lipoprotein alterations in nephrosis were discussed in detail in a previous report (1). It was found that there were qualitative as well as quantitative differences in lipoproteins from one patient to another. Despite the differences in lipoprotein pattern, concentrations of serum cholesterol and phospholipids were related inversely to concentrations of serum albumin in a fairly regular manner. Triglycerides were consistently increased only when serum albumin fell below levels of about 1 g per 100 ml. These and other (2) observations suggest that hyperlipoproteinemia in nephrosis may be at least in part a result of hypoalbuminemia.In order to study the effects on serum lipoproteins of altering the level of serum albumin without altering the disease, repeated infusions of serum albumin were administered to patients with nephrosis. Serum lipids and lipoproteins decreased as a result of the infusions. The decreases often were selective, involving principally the particular fractions which were most excessive at the beginning of the infusions. Changes in lipids and lipoproteins during infusions of dextran, and during steroid-induced remissions of the disease, were studied in several patients for comparison with the albumin results. METHODSPatients. The subjects were 9 patients with nephrosis (nephrotic syndrome) of unknown etiology. Age of the patients ranged from 5 to 46 years. Edema was present in all but one patient and proteinuria (4 to 15 g per day) was present in all cases prior to the initial course of infusions. A majority of the subjects was hospitalized, fed a low sodium diet, and studied for periods of several weeks before infusions were started. Body weight and levels of serum albumin, serum lipids, and urine protein were reasonably steady, except in Patient R.B., in whom steroid therapy had recently been discontinued, and in one additional patient who was excluded as noted later. Diet, schedule of activities, and other conditions were continued without change throughout the experimental periods. Quantity of food consumed was not rigidly controlled but did not change appreciably.Albumin infusions. The courses of albumin with one exception consisted of a total of 175 to 1,075 g, given over periods of 7 to 26 days, in quantities of 25 or 50 g per day with a few exceptions which are noted. The albumin preparation was salt-poor Cohn fraction V in 25 per cent solution, supplied by the American National Red Cross. Each infusion was administered intravenously over a period of 1 to 2 hours, starting about 7:30 a.m., after first obtaining blood specimens for analysis if desired. Because of the rapid loss of albumin in the case of W.T., a final infusion of 90 g was given slowly over a 10 hour period.Dextran infusions. One patient (F.G.) who had previously received albumin, was given 3 daily infusions of dextran in isotonic sodium chloride solution, and another patient (F.N.), a 30 year old male, was given 4 daily infusions of dextran in water. A third patient who received dextran, with results rese...

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“…The effects of albumin infusions on serum albumin concentration, proteinuria and edema were similar to those generally noted by previous investigators (28)(29)(30)(31)(32) …”

Section: Effects Of Albumin Infusionssupporting

confidence: 87%

Effects of Infusions of Serum Albumin on Serum Lipids and Lipoproteins in Nephrosis

Baxter¹,

Goodman²,

Allen³

1961

J. Clin. Invest.

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“…It has been suggested that increased glomerular filtration of protein is the initiating lesion in the nephrotic syndrome [3,5,6,9,15,20,21], but direct evidence for this has been lacking. In a recent study of the ultrastructure of the glomerulus in aminonucleoside nephrosis, Venkatachalam and coworkers [21] have reported that horseradish peroxidase (molecular weight 40,000) crosses the glomerular capillary barrier into the urinary space in nephrotic rats.…”

Section: Discussionmentioning

confidence: 99%

Micropuncture Study of Albumin Transfer in Aminonucleoside Nephrosis in the Rat

Lewy

Pesce

1973

Pediatr Res

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ExtractAlbumin concentration in the proximal tubules of normal rats and rats with aminonucleoside nephrosis (AMN) was estimated by means of a sensitive radioimmunoassay. Nephrotic animals were studied at the onset of proteinuria and when the nephrotic syndrome was fully established. Albumin concentration in the proximal tubule of normal male rats averaged 2.5 ± 0.3 mg/100 ml, whereas in early nephrotic rats it averaged 4.9 ± 1.3 mg/100 ml and in normal sized tubules of heavily proteinuric rats, 15.7 ± 3.3 mg/100 ml. Control and early AMN animals appeared to have a relatively homogeneous population of surface convolutions, whereas the fully nephrotic rats had markedly increased heterogeneity. A population of dilated proximal tubules with an albumin concentration of 233.8 ± 35.4 mg/100 ml was found in this group. Albumin concentrations were randomly distributed throughout the proximal convolution of all three groups with no clear pattern of changing concentration along the nephron. The data demonstrate that enhanced glomerular permeability to albumin occurs in the experimental nephrotic syndrome in the rat. Speculation

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“…Therefore, it remains possi ble that in some patients a relative hypovolemia may be one of the factors contributing to the sodium retention. This is also suggested by the fact that expansion of the plasma volume by infusion of hyperoncotic albumin oc casionally causes natriuresis in nephrotic patients [6,7], and by the natriuretic response during water immersion studies [8,9].…”

Section: Introductionmentioning

confidence: 99%

Effects of Plasma Volume Expansion on Renal Salt Handling in Patients with the Nephrotic Syndrome

Koomans¹,

Geers²,

Meiracker³

et al. 1984

Am J Nephrol

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In 10 patients with the nephrotic syndrome (NS) and edema persisting despite a NaCl-poor diet, the effect of a single infusion of hyperoncotic albumin (75 g) on NaCl excretion was studied. 6 patients had minimal lesions, and 2 patients were studied twice. On half of the occasions the glomerular filtration rate was reduced. Blood volume (BV), calculated from plasma volume and hematocrit, was slightly elevated before infusion, and increased to 136 and 120% of normal at 4 and 20 h after it, respectively. Plasma renin activity (PRA) and plasma aldosterone (PA) both decreased to suppressed levels at 20 h after infusion. Sodium excretion increased from 9.2 ± 7.6 μEq/min before, to 31.0 ± 22.4 (0–4 h) and 43.1 ± 36.3 μEq/min (4–20 h) after infusion. In 6 of these patients clearance studies were done before and after the infusion, maximal free water clearance being used as marker for distal NaCl reabsorption. Proximal fractional NaCl reabsorption was elevated before (94.9 ± 1.4%) and decreased after the infusion (92.8 ± 1.7%). Distal fractional NaCl reabsorption was also elevated before (93.0 ± 6.4%), but unaltered after infusion (93.0 ± 5.6%). Thus, after marked expansion of BV and suppression of PRA and PA, sodium excretion remained low despite the present edema. The results indicate that in many patients with the NS, including minimal lesion NS, intravascular hypovolemia is not the sole cause of sodium retention.

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A Study of the Mechanisms of Edema Formation in Patients with the Nephrotic Syndrome 1

Cited by 47 publications

References 39 publications

Effects of Infusions of Serum Albumin on Serum Lipids and Lipoproteins in Nephrosis

Effects of Infusions of Serum Albumin on Serum Lipids and Lipoproteins in Nephrosis

Micropuncture Study of Albumin Transfer in Aminonucleoside Nephrosis in the Rat

Effects of Plasma Volume Expansion on Renal Salt Handling in Patients with the Nephrotic Syndrome

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