Introduction

• A presenting sign of lower than normal serum protein levels (<2.6 g serum albumin/dl).
• Cause: secondary to another primary disease process causing protein loss or decreased protein synthesis/availability:
  • Protein-losing enteropathy Protein-losing enteropathy.
  • Protein-losing nephropathy.
  • Impaired protein synthesis/absorption.
  • Protein deficiency/loss.
• Signs: signs of primary disease process until chronic when generalized peripheral edema, pleural/abdominal effusion, weight loss.
• Diagnosis: laboratory tests.
• Treatment: treat primary disease process.
• Prognosis: depends on primary disease process.

Pathogenesis

Etiology

• Depends on primary disease process.

Protein losing enteropathies

• Lymphangiectasia/protein losing enteropathy Protein-losing enteropathy.
• Chronic inflammatory bowel disease Inflammatory bowel disease: overview.
• Chronic gastritis Stomach: chronic gastritis.
• Gastrointestinal neoplasia Alimentary tract: neoplasia.
• Gastrointestinal histoplasmosis Histoplasma capsulatum.

Protein losing nephropathies

• Glomerulonephritis Glomerulonephritis.
• Renal amyloidosis Amyloidosis.
• Lyme nephritis.

Impaired protein synthesis/malabsorption

• Chronic liver disease Liver: chronic disease - overview.
• Maldigestion Maldigestion.
• Malabsorption Malabsorption.

Protein deficiency

• External hemorrhage Trauma: overview.
• Prolonged malnutrition.
• Prolonged feeding of protein-restricted diet.

Pathophysiology

• Primary disease process causes increased loss, reduced uptake or decreased availability of protein → reduced serum protein levels.

• Decreased plasma protein → hypoalbuminemia → decreased plasma osmotic pressure → fluid transudation from capillaries → generalized peripheral edema and pleural/abdominal effusions → pleural effusion/ascites → clinical signs.

Timecourse

• Chronic condition before signs seen.

Diagnosis

Treatment

Outcomes