Hypoproteinemia nephrotic syndrome

Plasma protein fractions are used to treat hypovolemic (low blood volume) shock that occurs as the result of bums, trauma, surgery, and infections, or in conditions where shock is not currently present but likely to occur. Plasma protein fractions are also used to treat hypoproteinemia (a deficiency of protein in the blood), as might be seen in patients with nephrotic syndrome and hepatic cirrhosis, as well as other diseases or disorders. As with human pooled plasma, blood type and crossmatch is not needed when plasma protein fractions are given. 

Nephrotic syndrome is a clinical and laboratory syndrome defined by heavy proteinuria (exceeding 3.5 g/1.73 m2 of body surface area in adults, or 40 mg/hr/m2 in children), accompanied by hypoproteinemia (mainly hypoalbuminemia), hypercholesterolemia (in severe cases also hypertriacylglycerolemia), lipiduria, and edema. 

Diagnosis of nephrotic syndrome depends on the identification of both the clinical signs (edema) and laboratory disorders (proteinuria, hypoproteinemia, hypoal-buminemia, hyperlipidemia). Lipid and coagulation abnormalities that also must be monitored are described in detail in the appropriate sections. 

Low serum copper and ceruloplasmin levels are found regularly in the nephrotic syndrome with hypoproteinemia (C3, M12). These patients were found to excrete 46-75 mg ceruloplasmin per 24 hours in the urine, and this and perhaps the concomitant loss of albumin-bound copper most probably explain the development of hypoceruloplasminemia and hypocupremia in this condition. 

Nephrotic syndrome is characterized by proteinuria greater than 3.5 g/day per 1.73 m, hypoproteinemia, edema, and hyperlipidemia. A hypercoagulable state may also be present in some patients. The syndrome may be the result of primary diseases of the glomerulus, or be associated with systemic diseases such as diabetes mellitus, lupus, amyloidosis, and preeclampsia. Hypoproteinemia, especially hypoal-buminemia, results from increased urinary loss of albumin and an increased rate of catabolism of filtered albumin by proximal tubular cells. The compensatory increase in hepatic synthesis of albumin is insufficient to replenish the protein loss, probably because of malnutrition. 

Renal failure, nephrotic syndrome, congestive cardiac failure, hypoproteinemia Dietary insufficiency Artifactual ... 

Hypervolemic hypotonic hyponatremia— increase in water without an equal increase in sodium. Occurs with cirrhosis, hypoproteinemia (low albumin), heart failure, and nephrotic syndrome. 

Albumin formation is generally stated to take place solely in the liver. The available evidence, reviewed by Madden and Whipple (219), favors this view, but is not compelling, does not exclude other possibilities, and leaves unexplained a number of discrepancies which are noted in certain disease states, for example, the marked hypoalbuminemia observed in some instances of the nephrotic syndrome associated with relatively little albuminuria, and in so-called idiopathic hypoproteinemia. In both these conditions, the serum albumin may reach extremely low levels yet there is no impairment of hepatic function that can be demonstrated by available methods (which does not, to be sure, exclude the possibility of a specific hepatic defect such as occurs in connection with prothrombin formation and other hepatic functions). 

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