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Hypoalbuminemia- Low albumin

Hypoalbuminaemia is low serum albumin level.Most abundant plasma protein Accounts for 75-80 % of normal plasma colloid oncotic pressure and 40-60 % of total protein content Half life 15-19 days.

Functions –Maintains colloid oncotic pressure- prevents leaking of fluid into the extravascular space Transports various agents Low-affinity , high capacity carrier of several different endogenous and exogenous compounds acting as a depot and a carrier of these compounds Binds atleast 40 % of the circulating calcium and is a co-transporter of hormones such as thyroxine , cortisol , testosterone , among others Main carrier of fatty acids Also binds to drugs and unconjugated bilirubin- making them less toxic Scavenges free oxygen radicals – antioxidant and exerting an antiplatelet effect ( prevents platelet aggregation )

Causes of low albumin include-Decreased production , Defective synthesis for e.g due to hepatocyte damage , Deficient intake of amino-acids , Increased loss of albumin – this can be 
 via GI tract renal process skin acute or chronic inflammation

Serum albumin levels are reggulated by –rate of hepatic synthesis and secretion exchanges between the intravascular and extravascular compartments lymphatic uptake alterations in volume of distribution protein degradation bosy losses

It can cause –peripheral and central oedema fatigue and excessive weakness – and other features of related nutritional deficiencies e.g Fe deficiency in celiac disease features of primary disease

Decreased production-rare cause significant and severe chronic hepatic impairment needs to happen before the levels drop to be noticeable chronic and advance cirrhosis

Nutritional deficiency-protein malnutrition e.g Kwashiorkor low protein consumption ( malnutrition )

Renal loss-nephrotic syndrome chronic kidney disease

Gastro-intestinal loss-inflammatory gastrointestinal diseases chronic protein loosing enteropathy ( PLE )

Exrtravascular loss loss of albumin from the intravascular to extravascular space

Acute and chronic inflammation –if due to acue inflammation – settled following resolution if persistent it happens due to cytokine release which causes ↑ ed vascular permeability , ↑ ed degradation & decreased synthesis these can include conditions as rheumatoid arthritis , granulomatous processes , most bacterial infections , vascilitis , ulcerative bowel disease and some parasitic infections

Cardiac failure –due to multiple factors which work in combination as
 malnutrition inflammation and cachexia hemodilution liver dysfunction protein loosing enteropathy ↑ ed extravascular loss

Other causes –hemodilution e.g ascites burns sepsis malignancy ,critical illness ( ↑ ed catabolism ) trauma and crush injuries after weight loss surgery sarcoma , amyloidosis

References

  1. Wiedermann CJ, Wiedermann W, Joannidis M. Causal relationship between hypoalbuminemia and acute kidney injury. World J Nephrol. 2017;6(4):176–187. doi:10.5527/wjn.v6.i4.176
  2. Gounden V, Jialal I. Hypoalbuminemia. [Updated 2020 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526080/
  3. Hypoalbuminaemia Medscape via https://emedicine.medscape.com/article/166724-overview#a4
  4. Reassessment of Albumin as a Nutritional Marker in Kidney Disease Allon N. Friedman* and Stephen Z. Fadem†‡ *Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana; † Kidney Associates, Houston, Texas; and ‡ Division of Nephrology, Baylor College of Medicine, Houston, Texas via https://jasn.asnjournals.org/content/jnephrol/early/2010/01/14/ASN.2009020213.full.pdf
  5. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients Amit Akirov, MD,a,b Hiba Masri-Iraqi, MD,a,b Alaa Atamna, MD,b,c Ilan Shimon, MDa,b a Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel; b Sackler School of Medicine, Tel Aviv University, Israel; c Internal
  6. Medicine C, Beilinson Hospital, Petach Tikva, Israel. via https://www.amjmed.com/article/S0002-9343(17)30800-8/pdf
  7. www.labpedia.net- Albumin

 

 

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