Effects of Infusion of Hyperoncotic Dextran in Children with the Nephrotic Syndrome1

James, John A.; Gordillo, G; Metcoff, Jack

doi:10.1172/jci103011

Cited by 24 publications

(4 citation statements)

References 18 publications

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“…Dextran caused no complications except for oliguria following the infusions in the third patient. Proteinuria increased significantly during two courses of dextran, in accord with previous observations (13). (14), malnutrition (15), kwashiorkor (16), or the hypercatabolic type of idiopathic hypoalbuminemia (17) in which low levels of serum albumin occur.…”

Section: Effects Of Albumin Infusionssupporting

confidence: 90%

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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Section: Effects Of Albumin Infusionssupporting

confidence: 90%

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

Baxter¹,

Goodman²,

Allen³

1961

J. Clin. Invest.

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“…(24), however, from calculations of albumin clearances and minimum concentrations of albumin in the glomeru lar filtrate in nephrotic subjects given albumin infusions, concluded that proteinuria was the result of increased permeability only. James et al (25), using dextran infusions, came to the same conclusion. Lauson et at.…”

mentioning

confidence: 69%

Medical Diseases of the Kidney

Dp¹

1957

Annu. Rev. Med.

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“…The clinical utility of non-albumin colloids, such as (hyperoncotic 12% dextran solution given at 1.2–1.8 g/kg body weight daily as a single dose or on 3–5 consecutive days), was previously investigated in children with nephrotic edema ( 59 ). The precise mechanism of action has not been clarified.…”

Section: Pharmacological Management Of Nephrotic Edemamentioning

confidence: 99%

Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome

Ellis

2016

Front. Pediatr.

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Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiological mechanisms, which enhance renal sodium (Na+) and water retention; this is known as the “underfill hypothesis.” Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions, the predominant mechanism of edema formation is “primary” or “pathophysiological,” Na+ and water retention; this is known as the “overfill hypothesis.” A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill). This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation, and management of such edema.

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Effects of Infusion of Hyperoncotic Dextran in Children with the Nephrotic Syndrome1

Cited by 24 publications

References 18 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

Medical Diseases of the Kidney

Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome

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