A Study of the Mechanisms of Edema Formation in Patients with the Nephrotic Syndrome 1

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Abstract
An attempt has been made to determine the importance of insufficiency of glomerular filtration as a cause of the excessive renal tubular reabsorption of salt and water in patients with the nephrotic syndrome. Following admn. of concentrated human plasma albumin, the clearance of endogenous creatinine-like chromogen (Ccr) increased in most patients; this increase correlated fairly well with increase in excretion of Na, chloride and water in a large number of clearance periods. In 3 patients, spontaneous diuresis was associated with an increase in Ccr or urea clearance. Even in a patient with normal to supernormal CCr, there was some relationship between diuresis and chloruresis and a further acute increase in Ccr. In this type of patient, other tubule functions (Tm for glucose or p-aminohippurate) were elevated above normal to a greater extent than was glomerular filtration rate. The fact that periods of change in salt and water excretion did not always correspond to periods of change in CCr suggests the operation of additional (tubular) factors. The relative importance of 2 types of glomerulo-tubular imbalance ("primary glomerular insufficiency" and "primary tubular preponderance") in the causation of water and salt retention in the nephrotic syndrome cannot be assessed at present.