Syphilis serum proteins

This syndrome is characterized by proteinuria >3.5 g/day, hypoalbuminuria <3 g/dl, hyperlip-idaemia with an elevation of serum cholesterol, edema and oval fat bodies and fatty casts in the urinary sediment. A variety of disorders may produce nephrotic syndrome but, in the majority of cases, no cause is found. It is appropriate to define the selection of studies from the history and physical examination. Tests to order are antinuclear antibody, rheumatoid factor, cryoglobulins, serum complement, HBsAg VDRL serology (syphilis), protein electrophoresis of the serum and urine and HIV. If the cause is unclear a renal biopsy is done to define the glomerular lesion as treatment may on the underlying glomerular lesion. 

Recognized in 1961 (KIO), these are now well described (B18) and mimic the syndrome of mixed cryoglobulinemia (see 6.13). Skin lesions in this condition are raised, painful, and edematous with or without necrosis. Biopsy always reveals arteritis with a mononuclear and neutro-phile infiltrate. There is in most cases a preceding history of rheumatoid arthritis, Sjogren s syndrome, syphilis, sarcoidosis or other hyperimmune states, and this will dominate the clinical findings. Rarely the protein interactions build up to a level presenting as a viscosity syndrome so that this group can overlap with 7.7.1 unless the serum is carefully examined. 

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