Hertel J, Rao R, Phillips TM, Kimmel PL
Cryoglobulinemia in HIV-infected patients with renal
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:421 1995
Many proteinuric HIV-associated nephropathy patients have no peripheral
edema despite hypoalbuminemia. In this study plasma colloid osmotic
pressure (COPpl) was calculated in proteinuric (> 2.5 gms/24 hrs),
hypoalbuminemic (<3.1 g/dl) patients with and without HIV infection and
with and without edema. HIV infected patients without edema had the same
low albumin of 2.3 as non-HIV infected patients who were edematous.
However, their higher globulin fraction of 3.8 vs. 2.5 g/dl led to a higher
COPpl of 17.1 vs. 12.9 mmHg (P<0.05). Edematous HIV infected patients
a low COPpl of 12.1 mmHg, and non-edematous non-HIV infected patients had a
higher COPpl of 18.8 mmHg. The authors conclude that relatively higher
oncotic pressures related to plasma globulins may delay the onset of edema
in HIV infected patients.
Comment:This study did not measure oncotic pressure
directly, but calculated it via formula. Furthermore, in general, renal
salt retention is felt to be a more important determinant of edema
formation than is plasma oncotic pressure. Because interstitial oncotic
pressure also falls with hypoalbuminemia, resulting in a less dramatic
drop in the difference between capillary plasma and interstitial oncotic
pressure (DP in the Starling equation), low plasma proteins may not
necessarily result in edema. Salt balance was not measured in this study.
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Am Soc Nephrol
Cryoglobylonemia not due to hepatitis