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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT  
Year : 2012  |  Volume : 23  |  Issue : 6  |  Page : 1251-1253
Bisalbuminemia during remission of nephrotic syndrome


1 Service d'hémodialyse- Premier Centre Médicochirurgical, Agadir, Morocco
2 Service de Néphrologie-Hémodialyse et Transplantation Rénale- HMIMV, Rabat, Morocco

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Date of Web Publication17-Nov-2012
 

   Abstract 

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome.

How to cite this article:
Akhmouch I, Alayoud A, Bahadi A, Zajjari Y, Montasser D, El Allam M, Oualim Z. Bisalbuminemia during remission of nephrotic syndrome. Saudi J Kidney Dis Transpl 2012;23:1251-3

How to cite this URL:
Akhmouch I, Alayoud A, Bahadi A, Zajjari Y, Montasser D, El Allam M, Oualim Z. Bisalbuminemia during remission of nephrotic syndrome. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 May 31];23:1251-3. Available from: http://www.sjkdt.org/text.asp?2012/23/6/1251/103570

   Introduction Top


The acquired bisalbuminemia, outside of the long-term antibiotic treatment, is an exceptional event. It manifests as a split band of albumin on plasma electrophoresis. This split reflects the presence at the same time of a normal plasma albumin and a modified albumin. We report a case of bisalbuminemia during the period of remission of nephrotic syndrome in minimal change lesion glomerulonephritis.


   Case Report Top


A 22-year-old female, without particular me­dical history, during her first pregnancy, pre­sented at 34 weeks of amenorrhoea with an edematous ascitic syndrome since the second trimester of her pregnancy. The examination on admission found generalized edema affecting the lower limbs, lips, abdomen and face. The blood pressure was recorded at 100/60 mmHg. The edema was bilateral, painless and soft. Biological assessment showed a pure nephrotic syndrome with a negative immunological balance without complement consumption. Morphological assessment showed normal size and well-differentiated kidneys, an evolutionary monofetus pregnancy corresponding to the gestational age. Caesarean delivery took place around the 36th week, giving birth to a child of 2 kg. Changes in maternal post-partum are cratered by the spontaneous regression of edema and partial remission of nephrotic syndrome. The histological study performed two months after delivery showed minimal change glomerulonephritis. During the partial remission, transient acquired bisalbuminemia was observed on the capillary electrophoresis, which disappeared after complete remission [Figure 1], [Figure 2], [Figure 3] and [Figure 4], but reappeared after relapse of nephrotic syndrome six months later.
Figure 1: First electrophoresis: Before the remission of nephrotic syndrome.

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Figure 2: Second electrophoresis showing the appearance of bisalbuminemia.

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Figure 3: Showing a clear bisalbuminemia (appearance in dunce cap).

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Figure 4: Disappearance of bisalbuminemia after remission of nephrotic syndrome

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   Discussion Top


Described for the first time in 1955 by Scheurlen, the bisalbuminemia, also known as para-albumin or allo-albumin, was defined as the coexistence of two types of serum albumin of different electrophoretic mobility in the same patient. [1] They reflect the presence of a second narrow peak in the albumin fraction and produce a profile dunce cap. They may be inherited or acquired. The hereditary bisalbuminemia is permanent and reflects the coexistence of two types of albumin. Overall, it has rare consequences in terms of morbidity, but some variants may have a different affinity from that of albumin to normal hormones, metal ions, fatty acids or drugs. [2],[3] Conversely, the acquired bisalbuminemia are usually transient. They result from structural changes of a portion of albumin circulating either by addition or subtraction of material. [3],[4]

It is a very rare situation and the incidence has been variously reported in the literature. In fact, only five cases have been reported before 1975, and its incidence has been estimated at 0.2% by Dach and All, and 0.033% by Jamal Ahmed et al. [5]

These changes of albumin may be related to various etiologies, [1] there may be diseases of the pancreas, especially of pseudocysts, and lysis protein by pancreatic enzymes would be responsible for the double peak. [6],[7] The betalactams can bind to albumin and change its electrophoretic migration. [8] Anecdotally, it may be monoclonal dysglobulinemia [9] or nephrotic syndrome (only two cases were reported in the literature). [5],[10]

The pathophysiological mechanism of the association with the nephrotic syndrome remains unclear, and the review of the literature does not establish a correlation between the bisalbuminemia and kidney in minimal change lesion glomerulonephritis. [5]

In conclusion, the bisalbuminemia associated with acquired nephrotic syndrome is a very rare disorder; hence, the importance of this case report.

 
   References Top

1.Bach-Ngohou K, Schmitt S, Le Carrer D, Masson D, Denis M. Les dysalbuminémies. Annales de Biologie Clinique 2005;63;127-34.  Back to cited text no. 1
    
2.AvRuskin TW, Juan CS, Weiss RE. Familial dysalbuminemic hyperthyroxinemia: A rare example of albumin polymorphism and its rapid molecular diagnosis. J Pediatr Endocrinol Metab 2002;15:801-7.  Back to cited text no. 2
[PUBMED]    
3.Tance Y, Deneuville T, Tiev KP, et al. Un pic transitoire sur l'électrophorèse des protides sériques. Revue de Médecine Interne 2009; 30:436-7.  Back to cited text no. 3
    
4.Rousseaux J, Debeaumont D, Scharfman A, Pommelet P, Dautrevaux M, Biserte G. Bisalbuminémies au cours des pancréatites: modifications structurales de la sérumalbumine humaine par les enzymes protéolytiques du pancréas. Clin Chim Acta 1976;71:35-46.  Back to cited text no. 4
    
5.Ahmad J, Khan AS, Siddiqui MA, Khan RU. Bisalbuminemia in Nephrotic Syndrome a case report. Jpn J Med 1984;23:45-7.  Back to cited text no. 5
    
6.Andre P. Garre M, Youinou P, Saleun JP. Les bisalbuminemies. Trois étiologies: Mutation héréditaire, antibiothérapie, pseudokyste du pancréas. Nouv Presse Med 1977;6:4123-4.  Back to cited text no. 6
    
7.Bachmeyer C, Grateau G, Dhote R, Dauchy F. Une autre électrophorèse insolite. Revue Médecine Interne 1996;17:5.  Back to cited text no. 7
    
8.Winter V, Rosenvall A, Heikkila S, von Essen R. Acquired bisalbuminemia in staphylococcal endocarditis treated with dicloxacillin. Scand J Infect Dis 1992;24:811-4.  Back to cited text no. 8
    
9.Dubost JJ, Deseubis T, Sauvezie B, Gentou C, Rampon S. A tricuspid electrophoretic pattern: Familial bisalbuminemia with monoclonal immunoglobulin. Pathol Biol 1985:33:837-8.  Back to cited text no. 9
    
10.Hoang MP, Baskin LB, Wians FH Jr. Bisalbuminuria in an adult with bisalbuminemia and nephrotic syndrome. Clinica Chimica Acta 1999;284:101-7.  Back to cited text no. 10
    

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Correspondence Address:
I Akhmouch
Service de Néphro-Hémodialyse, Etat Major General, Agadir
Morocco
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DOI: 10.4103/1319-2442.103570

PMID: 23168859

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
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    References
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