ABSTRACT
OBJECTIVE: Ten adult subjects with nephrotic syndrome and modest aberrations on renal biopsy were studied before and after 13 steroid inhaler remissions to assess the effects of a seasoning diet.
METHOD: They were chosen because the results, which showed that all of them had a minor to moderate rise in blood volume and that several of them had raised blood pressure levels, were unexpected given the predicted hypovolemia.
RESULTS: Plasma renin activity (PRA) increased in 8 patients after remission and reduced in 3, whereas blood pressure dropped in 12 patients but plasma volume rose in 10. All seven patients had an improvement in their ability to clear creatinine, however, only four of the seven patients saw an improvement in their ability to clear radioactive chromium sulfate (Cr) EDTA. Contrarily, in the nephrotic phase, the tub Hippurate clearance (renal plasma flow) was either normal or rose and declined in five of seven instances, causing the extremely low filtration percentage to rise toward the normal range.
CONCLUSIONS: These findings contradict the widely held belief that the major cause of the persistence of the edema in this situation is hypovolemia and instead raise the possibility that other variables, such as reduced glomerular permeability, may be significant. Despite the fact that no combined measures of these hemodynamic parameters have been recorded in a patient population with a comparable clinical profile, a wealth of evidence from the literature indicates that people with an established nephrotic syndrome often exhibit hypervolemia to some extent.
KEYWORDS: edema, nephrotic syndrome, lesion