Serum Proteins (Alpha, Beta, and Gamma Globulins) and Oncotic Pressure in Ghanaian Patients with Nephrotic Syndrome

Abstract

Background: Nephrotic syndrome, which involves the leakage of serum proteins, especially albumin, into urine, is an important cause of chronic kidney disease (CKD) in sub-Saharan Africa, and hence constitutes a major threat to public health. Nonetheless, current studies on the condition are limited, especially in Africa. Moreover, studies reporting on proteinuria and oncotic pressure in patients with nephrotic syndrome have predominantly focused on the predominant protein lost – albumin. However, to compensate for the absence of albumin, the liver synthesizes other proteins. Yet, little is known about these other proteins, and their clinical relevance is yet to be fully elucidated. General aim: To investigate oncotic pressure, albumin and non-albumin proteins in the serum of Ghanaian patients with and without nephrotic syndrome Methodology: This was a case-control study involving ninety-nine (99) individuals with nephrotic syndrome (comprising of 51 males and 48 females) and forty-seven (47) individuals without the disease (comprising of 21 males and 26 females) aged up to 91 years recruited at MDS-Lancet Laboraroties Ghana Limited. Socio-demographic and clinical data of study participants were gathered by means of a standard questionnaire and a review of patients’ laboratory request forms. Six milliliters (6 ml) of venous blood sample was taken from each participant, and used to determine albumin, and different globulins in serum, as well as colloid osmotic pressure. Electrophoresis technique was also used to separate proteins, with various fractions determined by a densitometer. The oncotic pressure was calculated using standard factors. Results: Of the 146 individuals who volunteered as participants of the study, males comprised 51.5% (n = 51) and females comprised 48.5% (n = 48) in the neprotic syndrome group, whereas in the control group, the males and females comprised 44.7% (n = 21) and 55.3% (n = 26) respectively. The mean age of the study participants was 46.95±22.19 years in the nephrotic syndrome group and 45.72±16.08 years in the control group. Serum levels of alpha-2-globulin, C-reactive protein, urea, gamma globulins, and calcium were significantly higher in the nephrotic syndrome group than in the control group, whereas a decrease was observed for transferrin, total proteins, albumins, beta-1-globulins, and colloid osmotic pressure. Moreover, serum levels of C-reactive protein (OR = 1.41, p = 0.005) and gamma globulin (OR = 4.12, p = 0.005) were independent risk factors, increasing the odds of occurrence of nephrotic syndrome by about one and a half and four folds respectively. Conclusion: The nephrotic syndrome group were found to have lost C-reactive protein, urea, gamma globulins, and calcium into the serum, co-occurring with a lower colloid osmotic pressure and serum levels of transferrin, total proteins, albumins, and beta-1-globulins compared to the control group. Levels of C-reactive protein and gamma globulin increased the odds of occurrence of nephrotic syndrome.