Salt-poor Human Albumin in Management of Nephrotic Syndrome

Abstract

in 4 (18 %) out of 22 patients. Though this did not cause symptoms it nevertheless emphasizes t;he need to avoid giving gentamicin for minor sepsis. But in life--threatening Gramnegative sepsis in hospital practice we believe gentamicin therapy is the treatment of choice. There is still a tendency to give inadequate doses of gentamicin because of excessive anxiety about its toxicity. Inadequately-treated serious Gramnegative sepsis has a high mortality. The presenit series shows that vigorous but closely monitored gentamicin therapy gives excellent results without significant toxicity.We therefore recommend t-hat peak serum concentrations should be measured from the first day of treatment and the dose modified accordingly until values of at least 5 ,ug/ml or preferably 8-12 ,ug/ml are achieved. Dosage should be reduced only if concentrations exceed 15 ,ug/ml. Further assays of peak concentrations should be made when the dosage is altered. Trough concentrations as well as peaks should also be measured when there is a change in renal function and at least twice weekly during prolonged therapy. Closer monitoring is necessary during renal dialysis or the oliguric/anuric phase of acute renal failure. The more important function of monitoring is to ensure that adequate peak serum concentrations are reached as soon as possible, provided ,there is no severe renal dysfunction.

Renal Handling of Sodium in the Nephrotic Syndrome

“…In 1950, Luetscher et al [35] and Orloff et al [36] independently documeted that no more than 50% of patients had a natri uretic and diuretic response to plasma infusion, although volume was restored in all patients. Similar results were obtained by hyperoncotic plasma infusions in cases with diuretic-resistant edema [37]. The natriuretic response to central volume expansion with head-out water immersion also varies widely from patient to patient [12,24,25].…”

Blood Volume and Sodium Retention in the Nephrotic Syndrome: A Controversial Pathophysiological Concept

“…When PV is experimentally expanded, all the consequences of a decreased volume should be abolished. It is well known that infusion of hyperoncotic albumin may induce natriuresis in patients with the NS, particularly if combined with a diuretic [27], However, in all the reported series this natriuretic effect was seen in about 50% of the treated patients [18,29,32,58,75,90], In particular, patients with decreased GFR [90] and elevated PRA [18,80] failed to respond. This means that some patients with the NS cannot excrete their excess extravascular volume despite intravascular volume expan sion and suppression of PRA and PAC to very low levels [18,29].…”

Renal Function during Recovery from Minimal Lesions Nephrotic Syndrome

“…In view of the low filtration fraction and the low plasma oncotic pressure during disease one would rather expect a fall in proximal tubular sodium reabsorption. In fact, there is no agreement at which nephron level the sodium reabsorption is enhanced in humans with MLNS, some studies indicating a proximal [7,10,18] and some a distal [6.19,20] tubular level. Micropuncture studies in rats with unilaterial nephrosis due to puromycin, which causes glomerular lesions comparable to those in minimal change disease, showed two facts [21].…”