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A Group Of Symptoms Marked By Edema Proteinuria And Hypoalbuminemia
Hypoalbuminemia occurs when albumin levels in the blood are very low. Albumin is a blood protein that makes up a significant portion of the blood plasma. Plasma is the liquid portion of the blood that holds the proteins and blood cells.As the main protein in blood plasma, albumin plays a role in many functions, including maintaining pressure in the blood vessels and transporting substances, such as hormones and medications.Albumin binds to many of these substances, including hormones and some drugs, to help them travel through the body. So when albumin levels are low, the blood may not be able to transport essential materials effectively.Albumin levels below 3.4 grams per deciliter (g/dL) are considered low.A range of health issues can cause hypoalbuminemia.Determining the cause of hypoalbuminemia is vital for effective treatment.Some of the most common causes of the syndrome include:Liver failure: The liver manufactures albumin. So albumin tests are often a part of liver-functioning checks. Many diseases can cause liver failure, including cirrhosis, liver cancer, hepatitis, alcohol-related liver disease, and fatty liver disease.Heart failure: Some people with acute heart failure develop low albumin levels, though the reason for this phenomenon is not well understood.Kidney damage: Problems with the kidneys may cause them to release large amounts of protein into the urine. This can take albumin from the blood, leading to hypoalbuminemia.Protein losing enteropathy: Some stomach and gastrointestinal conditions, including celiac disease and inflammatory bowel disease, can cause the digestive system to lose a lot of protein. This causes a syndrome called protein losing enteropathy that can lead to low albumin levels.Malnutrition: People may develop hypoalbuminemia when they do not eat enough key nutrients, or medical conditions make it hard for their bodies to absorb nutrients. Some undergoing chemotherapy may be malnourished.Less frequently, people can develop hypoalbuminemia as a result of a serious burn, a blood infection called sepsis, allergic reactions, lupus, hypothyroidism, or diabetes.While a doctor tries to find out the reason for hypoalbuminemia and start treatment, some strategies can reduce the risk of serious complications.Some people may need medications to raise their albumin levels. This can include albumin administered via an intravenous needle.The best option for treating hypoalbuminemia is to address the underlying cause. So people may need to have a variety of tests to determine why there is not enough albumin in their blood.Treatment may include:blood pressure medication for people with kidney disease or heart failurelifestyle changes, particularly avoiding alcohol in people with liver diseasemedications to manage chronic gastrointestinal disease or reduce inflammation in the bodymedications, such as antibiotics, if a person has hypoalbuminemia after a severe burndietary changes to reduce the severity of heart or kidney diseasePeople experiencing hypoalbuminemia due to organ failure may need an organ transplant. People with kidney disease may need dialysis as they await a kidney transplant.People with hypoalbuminemia may need to be hospitalized and monitored until the condition is corrected.Share on PinterestJaundice, dry skin, and thinning hair are potential symptoms of hypoalbuminemia.A person may experience a wide range of symptoms, such as confusion, dizziness, and low energy if they are malnourished, for example.Some common symptoms of hypoalbuminemia include:excess protein in the urine shown by a urine testfluid retention that causes swelling, especially of the feet or handssigns of jaundice, including yellow skin or eyesfeelings of weakness or exhaustionrapid heartbeatvomiting, diarrhea, and nauseaappetite changesthinning hairvery dry or itchy skinIt is impossible to diagnose low albumin by some of the symptoms alone, and many symptoms associated with low albumin are also linked to other conditions.Albumin is present in many animal products. These include:beefmilkcottage cheeseeggsfishGreek yogurtSome nutritional supplements and meat substitutes may also contain albumin.People who consume enough protein will usually also get sufficient albumin. Most people need a minimum of 0.8 grams of protein per kilogram of body weight per day.It is important to note that many cases of hypoalbuminemia occur in people who do eat enough albumin. Even in people who eat a healthy diet, underlying diseases can make it difficult to absorb and use albumin and other nutrients.Hypoalbuminemia can worsen the effects of other diseases. A 2015 study found that people with chronic obstructive pulmonary disease (COPD) and hypoalbuminemia were more likely to experience respiratory failure.Other complications include:buildup of fluid, including around the lungs and stomachpneumoniamuscle damageHypoalbuminemia may also decrease the effectiveness of certain medications that need to bind to albumin.Share on PinterestThe outlook for hypoalbuminemia depends on how quickly the cause is identified and treated.The outlook for people diagnosed with low levels of albumin in the blood depends on the cause.Prompt diagnosis and treatment can improve long-term outlooks.The right treatments can be lifesaving.Some research suggests that low albumin levels may predict worse outcomes in people who have to be hospitalized.A 2014 study, for example, followed 5,451 people whose albumin levels were tested after being admitted to a hospital emergency department. Those with low albumin tended to be older and remained in the hospital longer.Overall, 16.3 percent of people with low albumin died in a 30-day period, compared to just 4.3 percent of people with normal albumin.This suggests that measuring albumin levels and diagnosing the cause of low albumin could improve outcomes in people admitted to the hospital.Low albumin suggests a person may have a specific health problem but, on its own, it does not provide much information about the reason.People with low albumin or those who suspect their albumin might be low should work with their doctor to find out what is causing the condition. When someone receives the correct treatment, their low albumin can be reversed.
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Nephrology – Proteinuria: By Manish Suneja M.D.
medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME.
Nephrology – Proteinuria
Whiteboard Animation Transcript
with Manish Suneja, MD
Proteinuria occurs when urinary excretion of protein is abnormally high (>150mg/day). It is important to distinguish transient and persistent proteinuria as it helps us to distinguish benign, self-limiting etiologies from more significant illnesses.
In fact the presence of proteinuria for more than three months with or without a decrease in glomerular filtration rate is diagnostic of chronic kidney disease.
The list of differential diagnoses for proteinuria includes almost any etiology of kidney disease.
Although there might be exceptions, the following framework is helpful in evaluating proteinuria:
1. Hematuria with overt proteinuria suggests glomerulonephritis
2. Significant proteinuria typically suggests glomerular diseases and plasma cell dyscrasias like multiple myeloma
3. Minimal to low-grade proteinuria indicates diseases that affect blood vessels
Proteinuria itself typically has few signs or symptoms. When there is significant proteinuria (especially nephrotic-range proteinuria), patients may notice edema in the extremities and face along with foamy urine.
Nephrotic range proteinuria may also result in volume overload and patients can present with pleural effusion and ascites. The presence of nephrotic-range proteinuria with edema, hypoalbuminemia, and hyperlipidemia is defined as nephrotic syndrome.
Proteinuria is often diagnosed incidentally on routine qualitative dipstick testing of urine sample. However, quantitative testing is important in evaluating proteinuria. The gold standard for confirming and quantifying proteinuria is a 24-hour urine collection. More recently, an acceptable alternative is calculating the protein-to-creatinine ratio and/or the albumin-to-creatinine ratio in a random urine sample.
Patients with chronic kidney disease, edema, acute kidney injury, hematuria, or suspected vasculitis should be tested for proteinuria. Moderately increased albuminuria (formerly called microalbuminuria) is particularly important because it signifies early stages of kidney disease. This should be a routine measurement in people with systemic conditions, like diabetes and hypertension, to screen for and detect nephropathy.
Management of proteinuria depends on the underlying pathology. For patients with intrinsic renal disease or systemic illnesses, treatment with Angiotensin Converting Enzyme inhibitors and Angiotensin Receptor Blockers are associated with improved renal outcomes. In instances where the diagnosis is not obvious or if there is significant proteinuria (3.5g/day), referral to nephrology is essential for further testing and management.
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