THE DEVELOPMENT OF THE NEPHROTIC SYNDROME DURING THE COURSE OF CONGESTIVE HEART FAILURE: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: J M THAYER, W J GLECKLER, R O HOLMES
Journal: Annals of Internal Medicine (1961)

Case Reports1 May 1961THE DEVELOPMENT OF THE NEPHROTIC SYNDROME DURING THE COURSE OF CONGESTIVE HEART FAILURE: CASE REPORT AND REVIEW OF THE LITERATUREJOHN M. THAYER, M.D., F.A.C.P., WILLIAM J. GLECKLER, M.D., F.A.C.P., ROBERT O. HOLMES, M.D.JOHN M. THAYER, M.D., F.A.C.P.Search for more papers by this author, WILLIAM J. GLECKLER, M.D., F.A.C.P.Search for more papers by this author, ROBERT O. HOLMES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-5-1013 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptEdema and other signs of fluid retention may occasionally increase rather than regress during the course of treatment of congestive heart failure with mercurial diuretics. This lack of response to treatment may be related to the severe nature of the cardiac lesion. Recently, however, Burack et al.1have described four cases of congestive failure which they felt led to the development of the nephrotic syndrome, characterized by heavy proteinuria, hypercholesterolemia, hypoalbuminemia, and edema. While many cardiologists and students of nephrosis find no causal relationship between the two disorders,2-13the case presented here suggested such an association and prompted a review...Bibliography1. BurackPryceGoodwin WRJJF: A reversible nephrotic syndrome associated with congestive heart failure. Circulation 18: 562, 1958. CrossrefMedlineGoogle Scholar2. Addis T: Glomerular nephritis. The Macmillan Company, New York, 1948. Google Scholar3. White PD: Heart disease. The Macmillan Company, New York, 1951. Google Scholar4. McManus JF: Medical diseases of the kidney. Lea and Febiger, Philadelphia, 1950. Google Scholar5. Bell ET: Renal diseases. Lea and Febiger, Philadelphia, 1950. Google Scholar6. Fishberg AM: Hypertension and nephritis. Lea and Febiger, Philadelphia, 1954. Google Scholar7. Luisada AA: Heart. The Williams and Wilkins Company, Baltimore, 1954. Google Scholar8. LuetscherPielCurtis JACFRH: The nephrotic syndrome. J. Chron. Dis. 1: 442, 1955. CrossrefMedlineGoogle Scholar9. Roscoe MH: The nephrotic syndrome. Quart. J. Med. 25: 353, 1956. MedlineGoogle Scholar10. Friedberg CK: Diseases of the heart. W. B. Saunders Company, Philadelphia, 1956. Google Scholar11. ScherfBoyd DLJ: Cardiovascular diseases. Grune and Stratton, New York, 1958. Google Scholar12. BermanSchreiner LBGE: Clinical and histologic spectrum of the nephrotic syndrome. Amer. J. Med. 24: 249, 1958. CrossrefMedlineGoogle Scholar13. Derow HA: The nephrotic syndrome. New Engl. J. Med. 258: 77 and 124, 1958. CrossrefMedlineGoogle Scholar14. Rytand DA: Fatal anuria, nephrotic syndrome, and glomerular nephritis as sequels of dermatitis of poison oak. Amer. J. Med. 5: 548, 1948. CrossrefMedlineGoogle Scholar15. Rytand DA: Onset of the nephrotic syndrome during reaction to bee sting. Stanford Med. Bull. 13: 224, 1955. MedlineGoogle Scholar16. SpainKing DMDW: The effect of penicillin on the renal lesions of subacute bacterial endocarditis. Ann. Intern. Med. 36: 1086, 1952. LinkGoogle Scholar17. WilsonThompsonHolzel VKMDA: Mercury nephrosis in young children. Brit. Med. J. 1: 358, 1952. CrossrefMedlineGoogle Scholar18. MunckNissen ONI: The development of the nephrotic syndrome during treatment with mercurial diuretics. Acta Med. Scand. 153: 307, 1956. CrossrefMedlineGoogle Scholar19. Boone JA: The determination of renal function in congestive heart failure. Southern Med. J. 37: 622, 1944. CrossrefGoogle Scholar20. Sprunt DH: Renal damage following administration of merbaphen (Novasurol). Arch. Intern. Med. 46: 494, 1930. CrossrefGoogle Scholar21. TarrJacobson LS: Toxicity of mersalyl (Salyrgan). Arch. Intern. Med. 50: 158, 1932. CrossrefGoogle Scholar22. Rosenthal M: The anatomic lesions of fatal mercurial intoxication from Salyrgan. Arch. Path. 15: 352, 1933. Google Scholar23. KlineSeymour EMWB: Systemic reactions to mercurial diuretics. Amer. J. Med. Sci. 203: 874, 1942. CrossrefGoogle Scholar24. BattermanDe GraffShorr RCACHM: Further observations on the use of Mercupurin administered orally. Amer. Heart J. 31: 431, 1946. CrossrefMedlineGoogle Scholar25. EvansMassumi JMRA: The long-term use of the oral diuretic, 3-chloromercuri-2-methoxypropylurea (Neohydrin) in ambulatory patients. Ann. Intern. Med. 44: 124, 1956. LinkGoogle Scholar26. SmallwoodMatthews WCHL: Systemic reactions to a mercurial diuretic (mercaptomerin). Lancet 1: 121, 1956. CrossrefGoogle Scholar27. KaplanZitmanSolarz.MillerMehlmanKaplan BMIHSDGJSLG: Clinical experience with a new oral diuretic, 3-chloromercuri-2-methoxypropylurea Neohydrin). J. Lab. Clin. Med. 42: 269, 1953. MedlineGoogle Scholar28. StewartMoore HJNS: The number of formed elements in the urinary sediment of patients suffering from heart disease with particular reference to the state of heart failure. J. Clin. Invest. 9: 409, 1930. CrossrefMedlineGoogle Scholar29. Goldring W: Observations on the clinical application of the urine sediment count (Addis). Amer. J. Med. Sci. 182: 105, 1931. CrossrefGoogle Scholar30. Thayer JM: Urinary abnormalities in congestive heart failure. Med. Ann. D. C. 29: 485, 1960. MedlineGoogle Scholar31. PaulVawterSchweitzerHass OGFAWGM: Pathological changes in congestive heart failure. Arch. Path. 64: 363, 1957. Google Scholar32. De GraffNadler ACJE: A review of the toxic manifestations of mercurial diuretics in man. J. A. M. A. 119: 1006, 1942. CrossrefGoogle Scholar33. Friedenson M: The prolonged use of mercurial diuretics in heart failure; report of a patient who received 627 injections. Ann. Intern. Med. 20: 306, 1944. LinkGoogle Scholar34. Brown EA: The question of reactions to mercurial diuretics. Ann. Allergy 13: 131, 1955. MedlineGoogle Scholar35. LeffNussbaum WAHE: Renal tolerance to long-term administration of organomercurial diuretics. Ann. N. Y. Acad. Sci. 65: 520, 1957. CrossrefMedlineGoogle Scholar36. Ray CT: Mercurial diuretics, their mechanism of action and application. Arch. Intern. Med. 102: 1016, 1958. CrossrefGoogle Scholar37. CoblentzMauriceLimaHebertLenegre BPEJJ: Evolution de l'abuminurie et de l'azotemie sous l'influence des diuretiques mercuriels au cours du traitement de l'insuffisance cardiaque. Bull. Soc. Méd. Hop. Paris 70: 764, 1954. MedlineGoogle Scholar38. RiddleGardnerBeswickFilshie MFII: The nephrotic syndrome complicating mercurial diuretic therapy. Brit. Med. J. 1: 1274, 1958. CrossrefMedlineGoogle Scholar39. BurstonDarmadyStranack JEMF: Nephrosis due to mercurial diuretics. Brit. Med. J. 1: 1277, 1958. CrossrefMedlineGoogle Scholar40. Clenner G: Mercurial diuretics and nephrosis. Brit. Med. J. 1: 1544, 1958. CrossrefMedlineGoogle Scholar41. QuinnZimmerman JRHJ: Significance of oval fat bodies in urinary sediment. Amer. J. Clin. Path. 24: 787, 1954. CrossrefMedlineGoogle Scholar42. Lippman RW: Urine and the urinary sediment. Charles C Thomas, Springfield, Illinois, 1957. Google Scholar43. DerowWolf HAL: Oral administration of Mercupurin tablets in ambulatory patients with chronic congestive heart failure. Amer. J. Med. 3: 693, 1947. CrossrefMedlineGoogle Scholar44. PreedyRussell JRDS: Acute salt depletion associated with the nephrotic syndrome developing during treatment with a mercurial diuretic. Lancet 2: 1181, 1953. CrossrefGoogle Scholar45. WaifePratt SOPT: Fatal mercurial poisoning following prolonged administration of mercurophylline. Arch. Intern. Med. 78: 42, 1946. CrossrefGoogle Scholar46. Lederer H: Mercurial diuretics and nephrosis. Brit. Med. J. 1: 1544, 1958. CrossrefMedlineGoogle Scholar47. Bruno MS: Fatal toxic nephrosis following the administration of mercurial diuretics. New Engl. J. Med. 239: 769, 1948. CrossrefMedlineGoogle Scholar48. Balslov JT: Nephrotic syndrome with bilateral thrombosis of renal veins in two patients with cardiac disease. J. A. M. A. 170: 1000, 1959 (Abstracts). Google Scholar49. SquireBlaineyHardwicke JRJDJ: The nephrotic syndrome. Brit. Med. Bull. 13: 43, 1957. CrossrefMedlineGoogle Scholar50. KarkPiraniPollakMuehrckeBlainey RMCLVERCJD: The nephrotic syndrome in adults. Ann. Intern. Med. 49: 751, 1958. LinkGoogle Scholar51. Starr I: The production of albuminuria by renal vasoconstriction in animals and in man. J. Exp. Med. 43: 31, 1926. CrossrefMedlineGoogle Scholar52. WegriaCapeciBlumenthalKornfeldHaysEliasHilton RNEMRPDRRAJG: The pathogenesis of proteinuria in the acutely congested kidney. J. Clin. Invest 34: 737, 1955. CrossrefMedlineGoogle Scholar53. RaceScheifleyEdwards GACHJE: Albuminuria in congestive heart failure. Circulation 13: 329, 1956. CrossrefMedlineGoogle Scholar54. ChinardLawsonEderGreifHiller FPHDHARLA: A study of the mechanism of proteinuria in patients with the nephrotic syndrome. J. Clin. Invest. 33: 621, 1954. CrossrefMedlineGoogle Scholar55. GregoireMalmendierLambert FCPP: The mechanism of proteinuria, and a study of the effects of hormonal therapy in the nephrotic syndrome. Amer. J. Med. 25: 516, 1958. CrossrefMedlineGoogle Scholar56. Merrill AJ: Nephrotic syndrome. Amer. Heart J. 53: 305, 1957. CrossrefMedlineGoogle Scholar57. Allen AC: The clinicopathologic meaning of the nephrotic syndrome. Amer. J. Med. 18: 277, 1955. CrossrefMedlineGoogle Scholar58. EhrichFormanSeifer WECWJ: Diffuse glomerular nephritis and lipoid nephrosis. Arch. Path. 54: 463, 1952. MedlineGoogle Scholar59. Merrill AJ: Edema and decreased renal blood flow in patients with chronic congestive heart failure. J. Clin. Invest. 25: 389, 1946. CrossrefGoogle Scholar60. EderLawsonChinardGreifCotziasVan Slyke HAHDFPRLGCDD: A study of the mechanisms of edema formation in patients with the nephrotic syndrome. J. Clin. Invest. 33: 636, 1954. CrossrefMedlineGoogle Scholar61. HellerJacobson BIWE: Renal hemodynamics in heart disease. Amer. Heart J. 39: 188, 1950. CrossrefMedlineGoogle Scholar62. DemingLuetscher QBJA: Bio-assay of desoxycorticosterone-like material in urine. Proc. Soc. Exp. Biol. Med. 73: 171, 1950. CrossrefGoogle Scholar63. LuetscherCurtis JARH: Aldosterone: observations on the regulation of sodium and potassium balance. Ann. Intern. Med. 43: 658, 1955. LinkGoogle Scholar64. WolffKoczorekBuchborn HPKRE: Hyperaldosteronism in heart disease. Lancet 2: 63, 1957. CrossrefGoogle Scholar65. JohnsonConn RDJW: Aldosterone, antidiuretic hormone, and congestive heart failure. Mod. Conc. Cardiov. Dis. 27: 431, 1958. MedlineGoogle Scholar66. BargerMuldowneyLiebowitz ACFPMR: Role of the kidney in the pathogenesis of congestive heart failure. Circulation 20: 273, 1959. CrossrefMedlineGoogle Scholar67. LangeStrangSlobodyWenk KRLBEJ: The treatment of the nephrotic syndrome with steroids in children and adults. Arch. Intern. Med. 99: 760. 1957. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication January 4, 1960.From the Departments of Medicine and Pathology, Peninsula Hospital, Burlingame, California.Requests for reprints should be addressed to John M. Thayer, M.D., 1515 Trousdale Drive, Burlingame, California. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySchistosomal glomerulonephritis: is it more prevalent in hepatosplenic patients when cor pulmonale is present?Albuminuria and the permselective properties of the glomerulus in cardiac failureImmunopathology of the nephrotic syndrome associated with renal vein thrombosisQuecksilberhaltige DiureticaNiere und HerzinsuffizienzDie pathologische Anatomie der intern-medizinisch bedeutsamsten NierenkrankheitenRenal Aspects of Cardiac Disease 1 May 1961Volume 54, Issue 5Page: 1013-1025KeywordsEdemaExcretionHeart failureHospital medicineLesionsPathogenesisProteinsProteinuriaUreaVasoconstriction ePublished: 1 December 2008 Issue Published: 1 May 1961 PDF downloadLoading ...