Hertel J, Rao R, Phillips TM, Kimmel PL
Cryoglobulinemia in HIV-infected patients with renal disease
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 had 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. (Pastan)

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Am Soc Nephrol
Proteinuria/Hematuria : HIV-associated nephropathy
Proteinuria/Hematuria : Cryoglobylonemia not due to hepatitis