Abstract
A reduction of effective plasma volume secondary to a decrease in the quantity of circulating protein is postulated to initiate edema formation in the nephrotic syndrome, however reduction of plasma volume has not been consistently demonstrated during active disease. Acute and chronic reduction of plasma volume is associated with an increased excretion of norepinephrine, presumably secondary to increased sympathetic activity. We therefore studied certain aspects of norepinephrine metabolism in thirteen children with the active nephrotic syndrome. All children were on a l½–2 mEq/kg/day sodium intake and no diuretic therapy. Plasma norepinephrine concentration was measured on two consecutive mornings and again four hours later each day. Albumin (6–18 grams) was infused 3 hours prior to the second blood sample on the second day. All samples were obtained from the antecubital vein after the subject had remained at 30 degrees tilt for 20 minutes. Eight of the thirteen children had increased plasma norepinephrine concentrations in the early morning (> 0.5 ng./ml). The plasma norepinephrine concentration measured following albumin infusion was significantly reduced whereas that obtained on the control day was not. Urinary excretion of conjugated norepinephrine declined significantly within 48 hours after the initiation of prednisone treatment in these subjects. These data suggest the presence of increased sympathetic activity during the active phase of the nephrotic syndrome which can be altered by the infusion of albumin or the administration of prednisone.
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Kelsch, R., Light, G. & Oliver, W. Plasma norepinephrine concentration before and after albumin infusion in nephrotic children. Pediatr Res 5, 383 (1971). https://doi.org/10.1203/00006450-197108000-00053
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DOI: https://doi.org/10.1203/00006450-197108000-00053