Nephrotic Edema Research Articles

ALBUMIN THERAPY IN NEPHROSIS

Twelve nephrotic children were treated with intravenous injections of low-sodium concentrated human plasma albumin. Favorable response, as judged by the decrease in weight and edema and the increase in diuresis, was only seen in five cases. Lack of therapeutic effect on nephrotic edema was due in the majority of cases to the great urinary loss of injected albumin and to the inability of the kidney to excrete the edema fluid mobilized into the circulation by the osmotic effect of albumin.

Syndrome characterized by glomerulonephritis and arthritis Libman-Sacks disease with predominantly renal involvement.

IN RECENT years we have studied an unusual group of cases to which we wish to draw attention. They show certain interesting similarities from both the clinical and the pathologic standpoint. The clinical courses in these cases and the terminal pictures have been such that we feel they constitute a definite, recognizable syndrome. The features these patients exhibited in common were an arthritis of varying duration, the subsequent development of albuminuria of rather marked degree, nephrotic edema, subsequent renal insufficiency and, finally, a fatal outcome with the pathologic findings of a subacute type of glomerulonephritis. The arthritis was the initially recognizable feature of the disorder. It was nonspecific in nature and characterized by pain, tenderness, stiffness, redness and swelling of the small and medium-sized joints. These symptoms were migratory, of mild or moderate intensity and transient, and they disappeared without leaving discernible permanent damage. In this stage no definite diagnosis

The relief of nephrotic edema by dextran infusions.

The relief of nephrotic edema by dextran infusions.

Intercapillary Glomerulosclerosis

IN 1936 a small series of cases was reported by Kimmelstiel and Wilson1 showing a conspicuous correlation between a syndrome of diabetes, nephrotic edema, gross albuminuria and hypertension and a peculiar type of intercapillary sclerosis of glomeruli. The nature of this investigation, taking its origin from systematic analysis of a large volume of autopsy material, precluded a specific detailed study of clinical features. The relatively scant clinical information was merely sufficient to emphasize the significance of the histologic findings. A large number of similar cases have been reported during the last twelve years, and with them a wealth of clinical . . .

INTRAVENOUS INJECTION OF ACACIA

The management of edema in patients with chronic glomerulonephritis complicated by the syndrome of hypoproteinemia and massive proteinuria continues to be unsatisfactory. The immediate cause of the edema is the reduced osmotic pressure resulting from the hypoproteinemia. No clinical methods are available at present by which one can stop the proteinuria or stimulate production of plasma protein so that the plasma protein concentration will rise sufficiently to eliminate the edema. Administration of acacia in the treatment of nephrotic edema was first reported by Hartmann in 1933. 1 Since that time, many clinical reports have appeared, and much experimental work has been done on this subject. For the most part these reports have been unfavorable, with the result that acacia is not used extensively in the treatment of nephrotic edema. The opposition to the use of acacia is based on the following observations: Cases have been reported in which there

ACACIA IN THE TREATMENT OF THE NEPHROTIC SYNDROME

The intravenous administration of solution of acacia to patients with a nephrotic type of edema is being employed by many physicians. Two of us (Goudsmit and Binger1) recently reviewed the literature on such treatment and reported experiences with this therapeutic adjunct in 40 cases, in 36 of which the patients were effectively and rapidly relieved of their edema. No harmful effects were noticed. It has been tacitly assumed by most investigators that the colloid osmotic pressure of the serum is increased after the introduction into the blood stream of quantities of acacia such as were employed with favorable results. Indeed, Kerkhof2reported 1 case in which there was extensive nephrotic edema and the serum exerted a colloid osmotic pressure of 8 mm. of mercury (109 mm. of water). Three hundred grams of acacia in 30 per cent solution was given in the course of three days. One hour

ACACIA IN TREATMENT OF THE NEPHROTIC SYNDROME

Elsewhere 1 two of us (A. G. and M. W. B.) have summarized our clinical experience with acacia in the treatment of nephrotic edema. In a consecutive series of 40 patients it was found that 36, or 90 per cent, could be relieved of edema when they followed a regimen of diet, ingestion of potassium nitrate and injections of acacia. The reason acacia originally was administered is obvious. It was thought that injections of solutions of this colloid material would increase the colloid osmotic pressure of the serum in cases of nephrotic edema and thus facilitate the reabsorption of the fluid resulting from edema. However, actual determination of colloid osmotic pressure before and after a therapeutic course of injections of acacia did not reveal consistent differences. Goudsmit, Binger and Power 2 found that after completion of a course of injections of acacia the colloid osmotic pressure in 43 per cent

ACACIA IN THE TREATMENT OF THE NEPHROTIC SYNDROME

The use of acacia intravenously in the treatment of nephrotic edema was first employed in a systematic manner by Hartmann and his associates 1 in 1933. They reported careful observations on 6 patients, all children, 5 of whom showed a satisfactory diuretic response after acacia was used (table 1). The daily dose amounted to 1 to 2 Gm. per kilogram of body weight in the majority of the cases. If necessary, administration was repeated at intervals of one day, two days or more. Of special interest is the observation of these authors that the renal lesion is likely to improve as diuresis is established, as was shown in their cases by a diminished amount of casts and a lessened degree of albuminuria. Improvement in renal function in 1 case was so great that a normal condition was completely reestablished, as was shown by absence of edema, normal urinary findings and

RELATION BETWEEN PLASMA PROTEIN LEVEL AND EDEMA IN NEPHROTIC CHILDREN

In 1930 Moore and Van Slyke¹presented data showing the relation between the plasma protein level and the occurrence of edema in adults with nephritis. Subsequently it was reported by Cowie, Jarvis and Cooperstock,²in 1930, by Calvin and Goldberg,³in 1931, and by Mitchell, Rittershofer, Wang, Kaucher, Wing and Hogden,⁴in 1938, that in children a somewhat lower protein level is compatible with freedom from edema; but no precise levels were given. In the present series of observations, the relation is shown between the level of the plasma protein, particularly the albumin fraction, and the presence of edema in children with the nephrotic syndrome. Epstein's view⁵has attained general acceptance; he stated that lowering of protein osmotic pressure in the plasma is the chief cause of nephrotic edema. Observation of the plasma protein level is important in assisting one to predict the degree of

Von gierke's glycogen storage disease: Case report with unusual findings

Summary 1.A rather typical case of von Gierke's disease is reported, theninth in the American literature. 2.The extreme anemia that occurred in this patient has not been mentioned in previous discussions of this disease. The very poor feeding habits in this patient could readily account for the blood picture. 3.A typical but transient nephrotic edema with marked albuminuria occurred; elevation in cholesterol also developed during the course of the disease. 4.The very rapid apparent cure is also extremely unusual, and weare unable to account for this. We are unable to state whether the liver extract or the pitressin had any effect in the rapid recovery. 5.No effort is made to discuss the cause of this syndrome, but it seems from this case that it is certainly a condition not limited to disturbance in the glycogen-glucose metabolism but that also the fat metabolism and other unknown factors are probably involved. Summary 1.A rather typical case of von Gierke's disease is reported, theninth in the American literature. 2.The extreme anemia that occurred in this patient has not been mentioned in previous discussions of this disease. The very poor feeding habits in this patient could readily account for the blood picture. 3.A typical but transient nephrotic edema with marked albuminuria occurred; elevation in cholesterol also developed during the course of the disease. 4.The very rapid apparent cure is also extremely unusual, and weare unable to account for this. We are unable to state whether the liver extract or the pitressin had any effect in the rapid recovery. 5.No effort is made to discuss the cause of this syndrome, but it seems from this case that it is certainly a condition not limited to disturbance in the glycogen-glucose metabolism but that also the fat metabolism and other unknown factors are probably involved.

THE USE OF THE MERCURIAL SUPPOSITORY AS A DIURETIC

Article1 May 1938THE USE OF THE MERCURIAL SUPPOSITORY AS A DIURETICJAMES FLEXNER, M.D.JAMES FLEXNER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-11-1962 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONOrganic mercurial compounds have been recognized as having valuable diuretic properties since 19201and have been used with increasing frequency since the introduction of salyrgan in 1924.2Later mercupurin (novurit), neptal and mercurosal were used. These drugs proved to be of great benefit in the treatment of cardiac edema, of moderate assistance in the management of nephrotic edema, and of lesser therapeutic value in the edema and ascites of hepatic cirrhosis. In addition to the known limitations, the drugs were objectionable because they were mercurials and thus renal irritants. Great care was therefore necessary in controlling their administration to...Bibliography1. SAXLHEILIG PR: Über die diuretische Wirkung von Novasurol und anderen Quecksilberinjektionen, Wien. klin. Wchnschr., 1920, xxxiii, 943. Google Scholar2. BERNHEIM E: Über das neue Quecksilberpräparat Salyrgan als Diuretikum, Therap. d. Gegenw., 1924, 538, 65. Google Scholar3. FLECKSEDER R: Über Anwendungs—und Wirkungsweise der komplexen Quecksilberdiuretika, Ztschr. f. Urol., 1934, xxviii, 32. Google Scholar4. ENGELEPSTEIN KT: Die Quecksilberdiurese, Ergebn. d. inn. Med. u. Kinderheilk., 1931, xl, 187. Google Scholar5. PARKINSONTHOMSON JWA: A mercurial (novurit) suppository as a diuretic for cardiac edema, Lancet, 1936, ccxxx, 16. CrossrefGoogle Scholar6. FULTON MN: Mercurin suppositories as a diuretic in the treatment of edema, New England Jr. Med., 1936, ccxiv, 1092. CrossrefGoogle Scholar7. HERRMANNDECHERD GGM: Further studies on the mechanism of diuresis with especial reference to the action of some newer diuretics, Jr. Lab. and Clin. Med., 1937, xxii, 767. Google Scholar8. ETHRIDGEMYERSFULTON CBDWMN: Modifying effect of various inorganic salts on the diuretic action of salyrgan, Arch. Int. Med., 1936, lvii, 714. CrossrefGoogle Scholar9. DENNIGDILLTALBOTT HDBJH: Bilanzuntersuchung einer Salmiakazidose, Arch. f. exper. Path. u. Pharmakol., 1929, cxliv, 297. CrossrefGoogle Scholar10. KEITH NM: The action and use of diuretics with especial reference to mercurial compounds, Jr. Am. Med. Assoc., 1936, cvii, 2047. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication December 20, 1937.From the Department of Medicine, New York Post-Graduate Medical School and Hospital, New York, N. Y.†Campbell Products, Inc., manufacturers of mercupurin and mercurin suppositories in this country, assure us that their products are identical with novurit and novurit suppositories. According to their statement, the term "novurit suppository" is misleading because the suppositories contain no theophylline. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byQuecksilberhaltige Diuretica 1 May 1938Volume 11, Issue 11Page: 1962-1972KeywordsAscitesCirrhosisDiureticsDrugsEdemaHospital medicineSuppository Issue Published: 1 May 1938 PDF downloadLoading ...

PLASMAPHERESIS EXPERIMENTS UPON THE INFLUENCE OF COLLOID OSMOTIC PRESSURE, WATER AND SALT IN EDEMA FORMATION

Article1 February 1938PLASMAPHERESIS EXPERIMENTS UPON THE INFLUENCE OF COLLOID OSMOTIC PRESSURE, WATER AND SALT IN EDEMA FORMATIONARTHUR C. KERKHOF, B.S., Ph.D., M.D.ARTHUR C. KERKHOF, B.S., Ph.D., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-8-1407 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNumerous investigators have produced edema by a reduction of the plasma proteins. The reduction of the plasma proteins by repeated bleedings is called plasmapheresis. Leiter1,2and Barker and Kirk3were the first to carry on this work. Since that time numerous investigators, chiefly Shelburne and Egloff,4Lepore,5Darrow, Hopper and Carey,6Weech, Snelling and Goettsch,7Kylin8and ourselves9,10have carried on these experiments. Our method of plasmapheresis has been essentially the following: Five to eight hundred cubic centimeters of normal blood were obtained from the right or left ventricle of a normal dog. This blood was citrated, centrifuged, the plasma...Bibliography1. LEITER L: Experimental nephrotic edema, Arch. Int. Med., 1931, xlviii, 1-32. CrossrefGoogle Scholar2. LEITER L: Experimental edema, Proc. Soc. Exper. Biol. and Med., 1928, xxvi, 173-175. CrossrefGoogle Scholar3. BARKERKIRK MHEJ: Experimental edema (nephrosis) in dogs in relation to edema of renal origin in patients, Arch. Int. Med., 1930, xlv, 319-346. CrossrefGoogle Scholar4. SHELBURNEEGLOFF SAWC: Experimental edema, Arch. Int. Med., 1931, xlviii, 51-69. CrossrefGoogle Scholar5. LEPORE MJ: Experimental edema produced by plasma protein depletion, Arch. Int. Med., 1932, l, 488-505. CrossrefGoogle Scholar6. DARROWHOPPERCAREY DCEBMK: Plasmapheresis edema. Relation of reduction of serum protein to edema and pathological anatomy accompanying plasmapheresis, Jr. Clin. Invest., 1932, xi, 683-699. CrossrefGoogle Scholar7. WEECHSNELLINGGOETTSCH AACEE: Relation between plasma protein content, plasma specific gravity and edema in dogs maintained on protein inadequate diet and in dogs rendered edematous by plasmapheresis, Jr. Clin. Invest., 1933, xii, 193-216. CrossrefGoogle Scholar8. KYLIN E: Studien über den kolloidosmotischen Druck; tierexperimentelle Untersuchungen über die Bedeutung der Senkung des kolloidosmotischen Druckes für die Ödempathogenese, Arch. f. exper. Path. u. Pharmakol., 1933, clxx, 407-416. CrossrefGoogle Scholar9. FAHRKERKHOFGIERE GAE: Salt as a factor in edema formation following plasmapheresis, Proc. Soc. Exper. Biol. and Med., 1931, xxviv, 335-336. CrossrefGoogle Scholar10. FAHRKERKHOF GA: Lowered colloid osmotic pressure leads to water and salt retention and edema formation, Proc. Soc. Exper. Biol. and Med., 1933, xxx, 1212-1213. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Minneapolis, Minnesota*Received for publication March 29, 1937.From the Department of Medicine, University of Minnesota, at the Minneapolis General Hospital. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPHAGEDENIC AND GANGRENOUS ULCERATION OF THE SKIN COMPLICATING ULCERATIVE COLITIS (PHAGEDENA GEOMETRICUM) 1 February 1938Volume 11, Issue 8Page: 1407-1415KeywordsBloodBlood plasmaEdemaHemorrhageHospital medicineLeft ventricleOsmotic pressurePlasma proteinsSalts Issue Published: 1 February 1938 PDF downloadLoading ...

NONCARDIAC EDEMA

Information concerning the chemical changes associated with the development of edema is being rapidly accumulated. These changes vary with the etiologic factors involved. In the extrarenal edema of nephrosis, for example, which Leiter¹reviewed a few years ago, several facts seem well established. Leiter summarized these "aphorisms" as follows: 1. All cases of active nephrosis present a significant proteinuria. 2. During the active stage, all cases of nephrotic edema present low total plasma proteins or low plasma albumin, and hence all present low protein osmotic pressure. 3. Nephrotic edema may disappear spontaneously or be absent in spite of albuminuria and low plasma proteins when the albumin-globulin ratio is high enough to give an osmotic pressure of the serum proteins above 20 cm. of water. 4. Nephrotic edema is more likely to yield to various diuretic measures when the plasma albumin is above than when it is below about 2

Effect of Intravenous Acacia on Physio-Chemical Properties of the Blood

Stimulated by the reports of Hartmann1 on the intravenous use of acacia, we were encouraged to give a clinical trial to certain cases of intractable nephrotic edema. This was followed by such marked diuresis and unusual reactions that it was deemed advisable to accumulate further knowledge on the subject. Extensive observations of these phenomena have been recorded by Bayliss,2 Henderson,3 and Hanzlik4 but with few observations on the oxygen content of the blood.This preliminary report of the effects of intravenous acacia solution on gaseous exchange and incidental findings, is to be followed by other observations on the physio-chemical factors of the blood.Dogs were used as the experimental animals. The standard apparatus of Van Slyke5 was employed for the gasometric content determinations by manometric method. Ten experiments were completed, which were uniformly consistent. A typical result is indicated in Table I.It will be noted that the hemoglobin fell with the red blood cells in direct proportion to...

THE USE OF ACACIA IN THE TREATMENT OF EDEMA

Following Epstein's 1 paper stressing the relationship between the reduction in concentration of plasma protein and noncardiac edema and the value of a high protein diet in the treatment of such edema, numerous communications, both experimental and clinical, have appeared that have confirmed the soundness of his ideas. An excellent critical review of this subject with a comprehensive bibliography may be found in Leiter's 2 monograph on nephrosis. As a result of such observations, the most widely accepted basic treatment of nephrotic edema has become the feeding of a high protein diet, together with restriction of salt and water, and the transfusion of whole blood or plasma. In analytic studies to be published elsewhere, the limitations of such treatment will be discussed. It will suffice here to say that, in the more severe cases of nephrosis, loss of plasma albumin through the kidney continues to equal or exceed the maximum