Is portal hypertension associated with protein-losing enteropathy?

Background and Aim:  Hypoalbuminemia in patients with decompensated cirrhosis has traditionally been assumed to be a result of to impaired liver synthesis; however, protein-losing enteropathy (PLE) may also contribute. The aim of this study was to assess whether hypoalbuminemic cirrhotic patients with portal hypertension had evidence of PLE.
Methods:  Sixteen patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension underwent whole gut lavage with polyethylene glycol solution. The effluent obtained was analyzed for albumin, immunoglobulin (Ig)G and α1-antitrypsin (α1-AT). Serum C-reactive protein (CRP) was also measured to assess the systemic inflammatory response.
Results:  Twelve of the 16 enrolled patients had a persistently low albumin concentration at the time of lavage. Only one patient (who was subsequently found to have celiac disease) had elevated concentrations of lavage albumin, α1-AT and IgG levels. There was a significant correlation between lavage albumin and α1-AT ( r  = 0.671, P  = 0.024), and between lavage albumin and IgG ( r  = 0.614, P  = 0.045). There was no correlation between serum albumin and lavage proteins. Six patients had elevated serum CRP levels, but serum albumin or lavage protein concentrations did not correlate with serum CRP.
Conclusion:  There is no evidence of a significant PLE in patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension.     

Detection of serum and urinary lipoprotein(a) in patients with renal diseases

We measured and analysed serum and urinary lipoprotein(a) [Lp(a)] in 73 patients with various renal diseases, and 168 control subjects. The results revealed that serum Lp(a) levels were significantly elevated in patients with mesangial proliferative glomerulonephritis, membranous nephropathy, chronic renal failure and diabetic nephropathy, except patients with IgA nephropathy (IgAN) with gross haematuria. Serum Lp(a) concentrations were found to be significantly correlated with serum albumin ( r =−0.5033, P <0.001) and urinary protein excretion ( r =0.3541, P <0.005), while not with serum creatinine ( r =−0.0144, P >0.05). Patients with selective urinary protein excretion had a lower serum Lp(a) level than those with non-selective urinary protein excretion. The correlation between serum albumin and serum Lp(a) levels remained significant ( P <0.001) after adjustment for serum creatinine, urinary protein excretion and the selectivity of urinary protein by multivariate regression analysis. Urinary Lp(a) excretion was decreased and related to the serum creatinine level ( r =−0.312, P <0.01). Our conclusion is that renal patients with proteinuria and hypoalbuminemia tend to have elevated levels of Lp(a) which are more significantly correlated to serum albumin levels than other parameters such as serum 24-h urinary protein, selectivity of urinary protein and serum creatinine; while urinary Lp(a) excretion varies inversely with serum creatinine levels.     

Risk factor(s) related to high membrane permeability in peritoneal dialysis

Aim: Peritoneal dialysis (PD) patients have different peritoneal membrane permeability (transport) characteristics. High peritoneal membrane permeability is associated with increased mortality risk in the patient population. In this study, we aimed to investigate possible risk factor(s) related to high peritoneal membrane permeability. Patients and method: The study included 475 PD patients (46.1?±?14.5 years of mean age; 198 female and 277 male). The patients were divided two groups according to peritoneal equilibration test (PET) result: high-permeability group (high and high-average) and low- permeability group (low-average and low). Results: In both the univariate and multivariate logistic regression analyses, it was found that diabetes mellitus and hypoalbuminemia was significantly associated with high peritoneal membrane permeability [relative risk (RR): 1.90, 95% confidence interval (CI): 1.26–2.86, p: 0.002 and RR: 2.14, 95% CI: 1.44–3.18, p<0.001, respectively]. Conclusion: Diabetes mellitus and hypoalbuminemia were closely associated with high peritoneal membrane permeability. Diabetic patients had 1.9 times the likelihood of having high permeability. However, the relationship between hypoalbuminemia and high peritoneal permeability appears to be a result rather than cause.     

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??Objective??To explore the relationship between hypoalbuminemia and disease severity and the prognosis in children with severe sepsis. Methods??From June 1??2015 to June 1??2017??119 cases diagnosed as sepsis complicated by hypoalbuminemia by retrospective were accepted PICU admission in Hunan Provincial Children’s Hospital. According to albumin levels in 24 h PICU admission into severe hypoalbuminemia group??≤ 25 g/L????moderate hypoalbuminemia group????30 g/L????mild hypoalbuminemia group????35 g/L?? and albumin normal group????35 g/L??. To analyze the changes of the severity and prognosis of severe sepsis in children with different albumin levels. Results??The incidence of hypoalbuminemia in children with severe sepsis was 71.43%. ??For children with severe sepsis??the lower the albumin levels??the higher the number of organ failure??and the higher the mortality??It’s negatively correlated??r??-0.457??P??0.000??. ??Single factor analysis found that with the serum albumin levels decreasing??the PRISM?? score was increased??the PICS score was decreased??the mechanical ventilation time??the hospital stay and PICU stay were increased. ??Multiple factor analysis showed that albumin level ≤ 25 g/L and MODS≥ 3 was independent risk factors for the prognosis of children with severe sepsis. Conclusion??The incidence of hypoalbuminemia in patients with severe sepsis is higher. The serum albumin level was inversely associated with the number of organ failure and disease severity??the lower albumin levels??the higher the illness??the worse prognosis.     

严重脓毒症患者血浆肾上腺髓质素/内皮素-1值与低白蛋白血症的相关性研究

目的:探讨严重脓毒症患者血浆肾上腺髓质素(AM)/内皮素-1(ET-1)值与并发低白蛋白血症的关系。方法:选择严重脓毒症患者38例,并以20例健康体检者作为正常对照组。采用放射免疫法测定2组血浆AM和ET-1水平。均数比较采用t检验,双变量资料采用直线相关分析。结果:①严重脓毒症组血浆AM、ET-1水平均增高,AM/ET-1值减低,与健康对照组比较有统计学意义(P0.05);②严重脓毒症患者血清白蛋白(ALB)水平降低,与健康对照组比较有统计学意义(P0.05);且ALB水平与AM/ET-1值呈显著正相关(P0.05)。结论:严重脓毒症患者并发低白蛋白血症与AM/ET-1值的降低相关。     

原发性小肠淋巴管扩张症1例报告并文献复习

目的探讨原发性小肠淋巴管扩张症(PIL)的临床表现及预后。方法回顾性分析1例PIL患儿的临床资料,并复习相关文献。结果患儿,女,5岁,生后逐渐出现进行性加重的腹胀、腹泻、全身水肿。实验室检查显示低白蛋白血症、淋巴细胞减少症、低丙种球蛋白血症。胃镜检查见十二指肠空肠弥漫的白色斑点,活检证实黏膜间质淋巴管扩张。确诊后予静脉输注白蛋白、利尿和调整饮食等治疗,病情很快缓解出院。结论原发性小肠淋巴管扩张症是一种罕见的蛋白丢失性肠病,诊断主要依靠小肠病理活检。早期诊断、及时饮食干预及肠外营养支持等可以很好改善患儿的症状和体征。     

Disease Severity Correlates with Thrombotic Capacity in Experimental Nephrotic Syndrome

Thrombotic disease, a major life–threatening complication of nephrotic syndrome, has been associated with proteinuria and hypoalbuminemia severity. However, it is not fully understood how disease severity correlates with severity of the acquired hypercoagulopathy of nephrotic syndrome. Without this knowledge, the utility of proteinuria and/or hypoalbuminemia as biomarkers of thrombotic risk remains limited. Here, we show that two well established ex vivo hypercoagulopathy assays, thrombin generation and rotational thromboelastometry, are highly correlated with proteinuria and hypoalbuminemia in the puromycin aminonucleoside and adriamycin rat models of nephrotic syndrome. Notably, in the puromycin aminonucleoside model, hyperfibrinogenemia and antithrombin deficiency were also correlated with proteinuria severity, consistent with reports in human nephrotic syndrome. Importantly, although coagulation was not spontaneously activated in vivo with increasing proteinuria, vascular injury induced a more robust thrombotic response in nephrotic animals. In conclusion, hypercoagulopathy is highly correlated with nephrotic disease severity, but overt thrombosis may require an initiating insult, such as vascular injury. Our results suggest that proteinuria and/or hypoalbuminemia could be developed as clinically meaningful surrogate biomarkers of hypercoagulopathy to identify patients with nephrotic syndrome at highest risk for thrombotic disease and potentially target them for anticoagulant pharmacoprophylaxis.     

Diffuse dermal angiomatosis associated with calciphylaxis in a patient with end‐stage renal disease

Diffuse dermal angiomatosis (DDA) represents a benign, acquired, reactive proliferation of vessels. DDA is clinically characterized by painful livedoid plaques with central ulceration, and the histopathologic hallmark is diffuse endothelial cell hyperplasia in the dermis. DDA has been rarely reported in association with calciphylaxis, a condition characterized by calcification of arterial walls with accompanying thrombosis and cutaneous necrosis. We present a case of a 72‐year‐old man with end‐stage renal disease on peritoneal dialysis who presented with painful lesions on his legs, and was found to have DDA in the setting of calciphylaxis. The possible pathogenesis linking DDA and calciphylaxis is discussed.