Portal de Periódicos da CAPES

Hypovolemic Shock and Hypotension as a Complication in the Nephrotic Syndrome

1964; American College of Physicians; Volume: 60; Issue: 2_Part_1 Linguagem: Inglês

10.7326/0003-4819-60-2-242

1539-3704

Hiroshi Yamauchi,

Cardiovascular Syncope and Autonomic Disorders

Article1 February 1964Hypovolemic Shock and Hypotension as a Complication in the Nephrotic SyndromeReport of Ten CasesHIROSHI YAMAUCHI, M.D., JAMES HOPPER JR., M.D.HIROSHI YAMAUCHI, M.D.Search for more papers by this author, JAMES HOPPER JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-2-242 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptClinical descriptions of circulatory insufficiency in the nephrotic syndrome are few despite the established observation that a reduction in blood volume is found in this disease state (1-15). According to Squire (13), total blood volume in patients with the nephrotic syndrome may be decreased to 70 to 80 per cent of normal. Acute decreases in blood volume of this magnitude in other clinical situations have often been associated with shock or hypotension (16-21).Between 1944 and 1960, we have seen the occurrence of shock or hypotension in 10 adult patients with the nephrotic syndrome. The patients were studied during periods...References1. PLESCH J: Hämodynamische Studien. Z. Exp. Path. Ther. 6: 380, 1909. CrossrefGoogle Scholar2. LINDERLUNDSGAARDVAN SLYKESTILLMAN GCCDDE: Changes in the volume of plasma and absolute amount of plasma proteins in nephritis. J. Exp. Med. 39: 921, 1924. CrossrefMedlineGoogle Scholar3. BROWNROWNTREE GELG: The volume and composition of the blood, and the changes incident to diuresis, in cases of edema. Arch. Intern. Med. (Chicago) 35: 129, 1925. CrossrefGoogle Scholar4. DARROW DC: The blood volume in cases of nephritis with edema and low serum protein concentration. Proc. Soc. Exp. Biol. Med. 23: 740, 1926. CrossrefGoogle Scholar5. BROWNROWNTREE GELG: Blood volume in edema of glomerular nephritis and nephrosis. Arch. Intern. Med. (Chicago) 41: 44, 1928. CrossrefGoogle Scholar6. CHANG HC: Plasma protein and blood volume. Proc. Soc. Exp. Biol. Med. 29: 829, 1932. CrossrefGoogle Scholar7. WATERFIELD RL: Changes in blood volume in patients with edema of renal origin. J. Clin. Invest. 9: 589, 1931. CrossrefMedlineGoogle Scholar8. HARRISGIBSON AWJG: Clinical studies of the blood volume. VII. Changes in blood volume in Blight's disease with or without edema, renal insufficiency or congestive heart failure, and in hypertension. J. Clin. Invest. 18: 527, 1939. CrossrefMedlineGoogle Scholar9. MACARTHUR P: The plasma volume in nephritis. Arch. Dis. Child. 21: 235, 1946. CrossrefMedlineGoogle Scholar10. BARNETTFORMANMCNAMARAMCCRORYRAPOPORTMICHIEBARBERO HLCWHWWMAJG: The effect of adrenocorticotrophic hormone on children with the nephrotic syndrome. II. Physiologic observations on discrete kidney functions and plasma volume. J. Clin. Invest. 30: 227, 1951. CrossrefMedlineGoogle Scholar11. STEINBECK AW: The plasma volume in glomerulonephritis. Clin. Sci. 12: 327, 1953. MedlineGoogle Scholar12. EDERLAUSONCHINARDGREIFCOTZIASVAN SLYKE HAHDFPRLGCDD: A study of the mechanisms of edema formation in patients with the nephrotic syndrome. J. Clin. Invest. 33: 636, 1954. CrossrefMedlineGoogle Scholar13. SQUIRE JR: Nephrotic syndrome. Advances Intern. Med. 7: 201, 1955. MedlineGoogle Scholar14. EISENBERG S: Hypervolemic syndrome associated with acute glomerulonephritis. Clin. Res. 6: 292, 1958. Google Scholar15. YAMAUCHIHOPPERMCCORMACK HJK: Blood volume and fainting in nephrosis. Clin. Res. 8: 195, 1960. Google Scholar16. EBERTSTEADGIBSON RVEAJG: Response of normal subjects to acute blood loss. Arch. Intern. Med. (Chicago) 68: 578, 1941. CrossrefGoogle Scholar17. COURNANDRILEYBRADLEYBREEDNOBLELAUSONGREGERSENRICHARDS ARLSEESRPHDMIDW: Studies of the circulation in clinical shock. Surgery 13: 964, 1943. Google Scholar18. NOBLEGREGERSEN RPMI: Blood volume in clinical shock. II. Extent and cause of blood volume reduction in traumatic, hemorhagic and burn shock. J. Clin. Invest. 25: 172, 1946. CrossrefGoogle Scholar19. FRANK HA: Present-day concepts of shock. New Eng. J. Med. 294: 445; 486, 1953. CrossrefGoogle Scholar20. BERSON SA: Blood volume in health and disease. Bull. NY Acad. Med. 30: 750, 1954. MedlineGoogle Scholar21. PRENTICEOLNEYARTZHOWARD TCJMCPJM: Studies of blood volume and transfusion therapy in the Korean battle casuality. Surg. Gynec. Obstet. 99: 542, 1954. MedlineGoogle Scholar22. HOPPER J: Creatinine clearance: a simple way of measuring kidney function. Bull. Univ. Calif. Med. Center 2: 315, 1951. Google Scholar23. TOBIASMCLAUGHLINHOPPER GJRFJ: Endogenous creatinine clearance. New Eng. J. Med. 266: 317, 1962. CrossrefMedlineGoogle Scholar24. HILLERGREIFBECKMAN ARLWW: Determination of proteins in urine by the biuret method. J. Biol. Chem. 176: 1421, 1948. CrossrefMedlineGoogle Scholar25. HAWKOSERSUMMERSON PBBLWH: Practical Physiological Chemistry 12th ed., The Blakiston Company, Philadelphia, 1947, p. 531. Google Scholar26. GORNALLBARDAWILLDAVID AGCJMM: Determination of serum proteins by means of the biuret reaction. J. Biol. Chem. 177: 751, 1949. CrossrefMedlineGoogle Scholar27. STERLINGGRAY KSJ: Determination of the circulating red cell volume in man by radioactive chromium. J. Clin. Invest. 29: 1614, 1950. CrossrefMedlineGoogle Scholar28. WENNESLANDBROWNHOPPERHODGESGUTTENTAGSCOTTTUCKERBRADLEY REJJLOEKGINB: Red cell, plasma and blood volume in healthy men measured by radiochromium (Cr51) cell tagging and hematocrit: influence of age, somatotype and habits of physical activity on variance after regression of volumes to height and weight combined. J. Clin. Invest. 38: 1065, 1959. CrossrefMedlineGoogle Scholar29. NOMOFHOPPERBROWNSCOTTWENNESLAND NJEKR: Simultaneous determinations of the total volume of red blood cells by use of carbon monoxide and chromium51 in healthy and diseased human subjects. J. Clin. Invest. 33: 1382, 1954. CrossrefMedlineGoogle Scholar30. AUSTCHOUMARVINBRACKNEYMOORE JBSMJFELGE: A rapid method for clinical total blood volume determination using radioactive iodinated human serum albumin (RIHSA). Proc. Soc. Exp. Biol. Med. 77: 514, 1951. CrossrefMedlineGoogle Scholar31. GIBSONEVANS JGWA: Clinical studies of the blood volume. I. Clinical application of a method employing the azo dye "Evans Blue" and the spectrophotometer. J. Clin. Invest., 16: 301, 1937. CrossrefMedlineGoogle Scholar32. ELKINTON JR: Physiology of body fluids, in Howell's Textbook of Physiology, 15th ed., edited by FULTON, J. F., W. B. Saunders Company, Philadelphia, 1946, p. 935. Google Scholar33. PETERS JP: The problem of cardiac edema. Amer. J. Med. 12: 66, 1952. CrossrefMedlineGoogle Scholar34. BROWNHOPPERHODGESBRADLEYWENNESLANDYAMAUCHI EJJLBRH: Red cell, plasma and blood volume in healthy women measured by radiochromium cell labeling and hematocrit. J. Clin. Invest. 41: 2182, 1962. CrossrefMedlineGoogle Scholar35. GIBSONEVANS JGWA: Clinical studies of the blood volume. II. The relation of plasma and total blood volume to venous pressure, blood velocity rate, physical measurements, age and sex in ninety normal humans. J. Clin. Invest. 16: 317, 1937. CrossrefMedlineGoogle Scholar36. WENNESLANDBROWNHOPPERSCOTTHODGESBRADLEY REJKGJLB: Experiences with the radiochromium method for determination of red cell volume. Scand. J. Clin. Lab. Invest. 14: 355, 1962. CrossrefMedlineGoogle Scholar37. GOODMANGILMAN LSA: The Pharmacological Basis of Therapeutics, 2nd ed., The Macmillan Company, New York, 1955. Google Scholar38. HONIGTENNEYGABEL CRSMPV: The mechanism of cardiovascular action of nitroglycerine. Amer. J. Med. 29: 910, 1960. CrossrefMedlineGoogle Scholar39. YAMAUCHIHOPPER HJ: Pure nephrosis in an adult patient: serial observations of blood volume, serum electrolytes, and renal function. Ann. Intern. Med. 55: 464, 1961. LinkGoogle Scholar40. FRIEND DG: Current concepts in therapy. Tranquilizers. II. The phenothiazines. 1. New Eng. J. Med. 260: 1028, 1959. MedlineGoogle Scholar41. DEROW HA: Repeated nephrotic episodes with normal urine, serum protein and cholesterol in edema-free intervals. New Eng. J. Med. 240: 131, 1949. CrossrefMedlineGoogle Scholar42. RYTANDCOX DAAJ: Polycyclic nephrotic syndrome. Amer. J. Med. 22: 297, 1957. CrossrefMedlineGoogle Scholar43. TALBOTCRAWFORDCOOK NBJDCD: Application of homeostatic principles to the management of nephrotic patients. New Eng. J. Med. 256: 1080, 1957. CrossrefMedlineGoogle Scholar44. YAMAUCHIHOPPERMCCORMACKLAMBERT HJKK: Hypovolemia in the nephrotic syndrome—a contraindication to renal biopsy. New Eng. J. Med. 263: 1012, 1960. CrossrefMedlineGoogle Scholar45. SCHNECKLOTHPAGE REIH: The nephrotic syndrome and chronic hypotension associated with primary systemic amyloidosis: report of a case. Amer. J. Med. Sci. 230: 299, 1955. CrossrefMedlineGoogle Scholar46. Case records of the Massachusetts General Hospital, Case No. 46291. New Eng. J. Med. 264: 140, 1960. Google Scholar47. Case records of the Massachusetts General Hospital, Case No. 33-1961. New Eng. J. Med. 264: 991, 1961. CrossrefMedlineGoogle Scholar48. VEREKING DWCE: The reaction to subcutaneous drainage in anasarca. Lancet 1: 779, 1960. MedlineGoogle Scholar49. CLARKSONTHOMPSONHORWITHLUCKEY BDMEH: Cyclical edema and shock due to increased capillary permeability. Amer. J. Med. 29: 193, 1960. CrossrefMedlineGoogle Scholar50. FARRMACFADYEN LEDA: Hypoaminoacidemia in children with nephrotic crises. Amer. J. Dis. Child. 59: 782, 1940. Google Scholar51. FARR LE: The significance of protein metabolism in the nephrotic child. J. Pediat. 17: 734, 1940. CrossrefGoogle Scholar52. JOHNSONREADER JRR: Prognosis in the nephrotic syndrome: a study with particular reference to the adults and older child. Aust. Ann. Med. 8: 200, 1959. MedlineGoogle Scholar53. READERJOHNSONGOULSTON RJRK: Nephrotic syndrome of acute onset with hypovolemia. Aust. Ann. Med. 2: 199, 1962. Google Scholar54. STEWARTROURKE JDGM: The effects of large intravenous infusions on body fluid. J. Clin. Invest. 21: 197, 1942. CrossrefMedlineGoogle Scholar55. GABUZDATRAEGERDAVIDSON GJHSCS: Hepatic cirrhosis: effects of sodium chloride administration and restriction and of abdominal paracentesis on electrolyte and water balance. J. Clin. Invest. 33: 780, 1954. CrossrefMedlineGoogle Scholar56. YAMAUCHIBIGLIERIHOPPER HEGJ: Blood volume and aldosterone secretion in hypertension and primary aldosteronism. Proc. Soc. Exp. Biol. Med. 107: 728, 1961. CrossrefMedlineGoogle Scholar57. WARRENMERRILLSTEAD JVAJEA: The role of the extracellular fluid in the maintenance of a normal plasma volume. J. Clin. Invest. 22: 635, 1943. CrossrefMedlineGoogle Scholar58. STARLING EH: The physiological factors involved in the causation of dropsy. Lancet 1: 1407, 1896. Google Scholar59. LANDISHORTENSTINE EMJC: Functional significance of venous blood pressure. Physiol. Rev. 30: 1, 1950. CrossrefMedlineGoogle Scholar60. GITLINJANEWAY DCA: An immunochemical study of the albumins of serum and urine, ascitic fluid and edema fluid in the nephrotic syndrome. J. Clin. Invest. 31: 223, 1962. CrossrefGoogle Scholar61. BENNHOLDKLAUSSCHEURLEN HDPG: Volume regulation and renal function in analbuminaemia. Lancet 2: 1169, 1960. CrossrefGoogle Scholar62. RAPAPORTYAMAUCHIGREENBROWNHOPPER EHJEJ: The central circulation in nephrotics. Fed. Proc. 19: 87, 1960. Google Scholar63. JOHNSON SR: The effect of some anaesthetic agents on the circulation in man with special reference to the significance of pulmonary blood volume for the circulatory regulation. Acta Chir. Scand. Supp. 158: 1, 1951. Google Scholar64. ETSTENLI BTH: Hemodynamic changes during thiopental anesthesia in humans: cardiac output, stroke volume, total peripheral resistance, and intrathoracic blood volume. J. Clin. Invest. 34: 500, 1955. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: HIROSHI YAMAUCHI, M.D.; JAMES HOPPERJR., M.D.Affiliations: San Francisco, CaliforniaFrom the Department of Medicine, University of California School of Medicine, San Francisco, California.This work was supported by grant H-1271 from the United States Public Health Service, Bethesda, Maryland, and by funds allocated by the Committee on Research of the University of California School of Medicine, San Francisco, California.Requests for reprints should be addressed to Editorial Office (Yl), Department of Medicine, University of California Medical Center, San Francisco 22, California.Dr. Yamauchi is a Captain in the Medical Corps of the United States Air Force, and the opinions expressed are those of the authors and in no way reflect the official views of the United States Air Force. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byChallenges in diuretic therapy: A case-based discussionNephrotic Syndrome: Classification and EvaluationNephrotic Syndrome: Classification and EvaluationPodocytopathiesAcute kidney injury complicating nephrotic syndrome of minimal change diseaseUrinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional studyAfferent mechanisms of sodium retention in cirrhosis and hepatorenal syndromeIntravascular Volume in Edematous States: Not Always What You ThinkPhysiology and Pathophysiology of Sodium Retention and WastageManagement of minimal lesion glomerulonephritis: Evidence-based recommendationsGlomerular causes of renal failureMechanisms and management of nephrotic edemaEdema of the Nephrotic Syndrome: The Role of the Atrial Peptide SystemSouthwestern Internal Medicine Conference: Nephrotic Edema—Pathogenesis and TreatmentAcute renal failure and non-Hodgkins lymphoma in a patient with minimal change glomerulonephritisIntra- and extrarenal factors of oedema formation in the nephrotic syndromeTherapie mit AlbuminThe Nephrotic Syndrome and Its ComplicationsEffect of changes in posture on circulatory homeostasis in patients with the nephrotic syndromeUrospasmAn Evaluation of Ultrafiltration as Treatment of Diuretic-resistant Oedema in Nephrotic SyndromeClinical Course and Renal Function in Minimal Change Nephrotic SyndromeRenin-Angiotensin-Aldosterone System in Nephrotic SyndromeAcute Renal Failure in Glomerular DiseasePathogenesis of Sodium and Water Retention in Edematous DisordersCase 4-1982Management of Nephrotic EdemaMore About Minimal ChangeRenal failure in minimal change nephrotic syndromeSecondary peritonitis due to rupture of the ileum in a nephrotic patientClinical varieties and treatment of nephritisREVERSIBLE ACUTE RENAL FAILURE IN THE NEPHROTIC SYNDROME WITH MINIMAL GLOMERULAR PATHOLOGYIrreversible acute renal failure in idiopathic nephrotic syndromePersistent Hypotension and Intestinal Infarction in A Patient with Primary AmyloidosisMembranous GlomerulonephritisJAMES HOPPER JR., M.D.Diuretic Properties of Furosemide in Renal DiseaseROBERT G. MUTH, M.D., F.A.C.P.Effects of Uremia on the Cardiovascular and Central Nervous SystemsCHANGES IN BLOOD-VOLUME PRODUCED BY TREATMENT IN THE NEPHROTIC SYNDROMESudden Death in the Nephrotic SyndromeHypovolemic shock complicating the nephrotic syndrome in childrenThe Safety of Percutaneous Renal Biopsy: An Analysis of 500 Consecutive Cases 1 February 1964Volume 60, Issue 2_Part_1Page: 242-254KeywordsBlood volumeHypotensionMedical servicesShock ePublished: 1 December 2008 Issue Published: 1 February 1964 PDF downloadLoading ...