Extracellular Fluid Volume in the Hypoalbuminemic Diabetic Patient

The number of people who have diabetes is increasing. Many develop significant complications associated with diabetes, such as neuropathy, retinopathy, and manifestations of cardiovascular disease. Overt diabetic nephropathy is diagnosed most often in patients who have longstanding diabetes and who develop hypertension, loss of renal function, peripheral edema, nephrotic range proteinuria, and hypoalbuminemia. This article discusses the changes in extracellular fluid volume in hypoalbuminemic patients who have diabetic nephropathy and changes in extracellular volume that occur in other forms of glomerular disease associated with hypoalbuminemia. This article also reviews the mechanisms responsible for hypoalbuminemia in proteinuric subjects who have chronic kidney disease.