Cases reported "Albuminuria"

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1/6. Bisalbuminuria in an adult with bisalbuminemia and nephrotic syndrome.

    Bisalbuminemia (or alloalbuminemia) is a relatively rare hereditary or acquired condition characterized by the presence of two distinct albumin bands, or, less commonly, a single widened albumin band, after agarose gel electrophoresis of serum. Bisalbumins are caused by point- or chain-mutations that occur with a population frequency of 1:10,000 to 1:1000. Although no adverse clinical effects have been attributed to bisalbumins, some albumin variants have altered affinity for steroid hormones, thyroxine, or drugs. We report a case of bisalbuminuria in a 25-year-old man with bisalbuminemia and nephrotic syndrome.
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ranking = 1
keywords = nephrotic syndrome
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2/6. Spontaneous remission of congenital nephrotic syndrome: a case report and review of the literature.

    Spontaneous remission of congenital nephrotic syndrome is rare. We present a 5-week-old infant who developed proteinuria, hypoalbuminemia, and edema which spontaneously resolved with supportive care. Clinical and histopathological features of this patient and six previous reported remissions of congenital nephrotic syndrome are discussed.
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ranking = 1.2
keywords = nephrotic syndrome
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3/6. enalapril and hydroxyurea therapy for children with sickle nephropathy.

    proteinuria in children with sickle cell anemia (SCA) is an early sign of sickle nephropathy, and portends the development of nephrotic syndrome and chronic renal failure. enalapril has been shown to reduce proteinuria in adult patients with SCA, but the potential benefits of hydroxyurea in this clinical setting have not been reported. A single institution retrospective analysis was performed. Children with sickle nephropathy were identified, and the laboratory effects of enalapril and hydroxyurea therapy were evaluated in children with substantial proteinuria. Three children developed proteinuria at 8 /- 1 years of age. Pre-treatment laboratory studies included a low serum albumin (2.8 /- 0.8 g/dl) and a highly elevated urine protein/creatinine ratio (6.9 /- 3.7, normal <0.2). enalapril treatment for 3.0 /- 1.3 years normalized serum albumin (3.9 /- 0.3 g/dl) without significant changes in serum potassium, serum creatinine, or systolic blood pressure. However, urine protein/creatinine remained elevated in the nephrotic range (1.6 /- 0.7). The addition of hydroxyurea therapy for 3.5 /- 1.2 years increased fetal hemoglobin levels (7.0 /- 3.6% to 21.0 /- 3.2%) and was associated with a near-normal urine protein/creatinine ratio (0.5 /- 0.1). enalapril therapy for children with sickle nephropathy reduces urinary protein excretion and normalizes serum albumin. hydroxyurea therapy may further normalize the urine protein/creatinine ratio. Combination therapy should be tested prospectively in children with sickle nephropathy.
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ranking = 0.2
keywords = nephrotic syndrome
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4/6. antithrombin iii and the nephrotic syndrome.

    plasma and urinary antithrombin iii (AT-III) was measured in 15 cases of nephrotic syndrome. plasma AT-III correlated well with serum albumin, but poorly with proteinuria, whereas urinary AT-III correlated well to proteinuria. The plasma AT-III level had a mean similar to 25 healthy controls, but the range was significantly wider. A case with nephrotic syndrome and left renal vein thrombosis is reported. The urinary output of AT-III rose and the plasma level fell with the activity of the disease. Although AT-III and albumin have similar molecule weight, their renal clearance was found to be different. It is suggested that urinary loss of AT-III plays a role in the hypercoagulable state sometimes found in the nephrotic syndrome.
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ranking = 1.4
keywords = nephrotic syndrome
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5/6. Medical nephrectomy. The use of metallic salts for the control of massive proteinuria in the nephrotic syndrome.

    Two patients with intractable massive proteinuria and uremia were followed and treated with standard mecial therapy and dialysis. After a period of study and demonstration of clinical deterioration both patients were given solutions containing sodium mercaptomerin. Within days there was a decline in urine protein excretion and a variable increase in serum protein concentration. The patients demonstrated an increase in blood pressure, which made hemodialysis treatment possible. No deleterious effects from the mercury salts were noted. These observations suggest that in selected cases nephrotoxic agents may be of value in decreasing massive proteinuria, and improving protein homeostasis in uremic patients. Table I: Possible advantages of medical nephrectomy. 1. Reversal of hypotension and shock 2. Ability to perform hemodialysis 3. No anesthesia or surgical risk 4. No angiography related complications 5. Preservation of endocrine function of kidney. Possible advantages of medical nephrectomy (Table I), are: 1) Correction of proteinuria and hypotension; 2) Ability to perform hemodialysis; 3) No anesthesia or surgical risk; 4) No angiography related complications; and 5) Preservation of remaining endocrine function of the kidney, including erythropoietic and vitamin d action. The ideal agent should be non-toxic to other organs and produce selective renal ablation. Obviously mercury is not the ideal agent, although in these cases it did not produce observable side effects. It appears that this agent should be used with caution and only in patients with irreversible renal failure.
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ranking = 0.8
keywords = nephrotic syndrome
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6/6. Antihuman immunoglobulin affinity immunoadsorption strongly decreases proteinuria in patients with relapsing nephrotic syndrome.

    Approximately 20 to 30% of patients with idiopathic nephrotic syndrome and focal glomerulosclerosis experience a relapse of their nephrotic syndrome after transplantation. Previously, it has been shown that ex vivo immunoadsorption on protein A strongly (although transiently) reduces proteinuria in relapsing patients. To investigate whether the factor(s) that give rise to albuminuria are bound directly to protein A in the immunoadsorption procedure or are part of a complex with Ig, four patients with relapse of focal glomerulosclerosis presenting as nephrotic syndrome after transplantation were treated, sequentially, using a (non-protein A) anti-Ig affinity column and a protein A column. This study reports that the effect on proteinuria of immunoadsorption using an anti-Ig immunoaffinity column is comparable in its magnitude and kinetics to that of immunoadsorption on protein A. The two procedures were also equally effective in depleting the relapsing patients' plasma of a factor capable of altering the albumin permselectivity of isolated glomeruli in vitro. This study demonstrates for the first time that immunoglobulins have a role in the nephrotic syndrome. In addition, the fact that the two different immunoadsorption procedures both resulted in the removal of the same putative albuminuric factor in these patients and that no autoreactivity of eluted immunoglobulins was observed on human tissues strongly suggests that the factor or factors that may be responsible for immediate nephrotic syndrome after transplantation are bound to an immunoglobulin. However, no firm evidence can be yet provided against a direct role of immunoglobulins.
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ranking = 1.8
keywords = nephrotic syndrome
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