oa South African Medical Journal - Serum cholinesterase activity and protein-bound iodine fluctuations during therapy of a case of nephrosis



A case of nephrosis in a child aged 3 years is recorded. Clinical recovery following treatment with cortisone and ACTH was accompanied by a dramatic reversal of the marked metabolic changes which occur in this disease (Fig. I and Table I). With the onset of diuresis as shown by rapid loss of body weight the albuminuria ceased abrupt1y, there was an increase in the serum albumin concentration and a gradual return of the A /G ratio to normal. The serum cholinesterase activity which was initially raised above 'normal' levels decreased rapidly below normal as the serum albumin level rose with cortisone therapy. An attempt is made to correlate the fluctuations in cholinesterase activity with the liver function in nephrosis and the effects of cortisone. In contrast to cholinesterase, the level of the serum protein-bound iodine (PBI), which was initially markedly below normal, appeared to be associated with cholesterol rather than with protein metabolism or proteinuria. The significance of this finding is discussed and it is suggested that the persistently low PBI following cessation of the albuminuria indicates that the loss of thyroid hormone in the urine attached to protein may not be the explanation for the low serum PBI. Its association with a persistently high serum-cholesterol level is in favour of a hypothyroid state.


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