Christen Lundsgaard

The globulin and albumin content of the plasma in nephritis

Bright and a number of subsequent observers have described a diminution of proteins in the plasma of some persons suffering from albuminuria and edema; and later it has also been found that the decrease occurs chiefly in the plasma albumin (Epstein) the globulin not being diminished. We have determined the albumin and globulin over varying periods of time in the plasmas of a number of nephritics by the recent method of Howe, with the results indicated below. The cases were classified as glomerular nephritis, nephrosis, and nephrosclerosis according to Volhard and Fahr. In glomsrular nephritis a return to a normal total protein content has been observed in some cases, but a return to a normal albumin: globulin ratio has not yet been observed in any of our cases. In one typical nephrosis patient a great loss of edema was observed without any change in plasma proteins, but after the edema had disappeared the total proteins began to rise towards the normal. The case of nephrosis with normal total content at the first examination was already ccrnvalescent.

The cause of low plasma protein concentration in nephritis

The reduction in concentration of plasma proteins observed in a considerable proportion of nephritic patients has been attributed by some authors to a decrease in the amount of plasma proteins in the body, by others to a dilution of the blood with water (hydremic plethora). We have made one or more determinations of the blood volume by Keith, Rowntree, and Geraghtys “Vital Red” method on all but three of the patients above reported with reduced plasma protein concentration, and on some others. The cause of the reduced protein concentration was found to be not hydremic plethora, but an actual decrease in the amount of plasma proteins in the body. Normal blood volumes were found, even in cases of extreme edema. The amount of total plasma proteins per kilo body weight (the weight being corrected as nearly as possible for estimated edema fluid present) however, varied from 1.5 to 3.0 grams, compared with 3.5 grams found in normal individuals.