Plasma protein abnormalities in nephrotic syndrome: effect on plasma colloid osmotic pressure and viscosity.

The concentrations of 25 plasma proteins were measured in 22 patients with membranous nephropathy. For some large proteins, the plasma concentrations were increased; there were also large proteins with low plasma concentrations, but small or medium-sized proteins showed uniformly lower plasma concentration than the controls. Plasma colloid osmotic pressure (pi) and viscosity (eta) were not interrelated but showed positive and significant correlations with plasma concentrations of small and medium-sized proteins (pi) and plasma concentrations of large proteins (eta), respectively. Nephrotic plasma is not efficient in maintaining plasma pi but highly efficient in maintaining plasma eta. High plasma fibrinogen concentrations and low antithrombin III concentrations may predispose to thrombosis, and low IgG concentrations may account for the higher predisposition to bacterial infection. The relative composition of nephrotic plasma is heavily dependent on the size of the different proteins. Plasma pi and eta are also maintained by the relative preponderance of different plasma proteins.