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GENERAL EDEMA OF INDETERMINATE ETIOLOGY: Title and subTitle BreakREPORT OF THREE CASES

MELVIN W. BINGER, M.D.; NORMAN M. KEITH, M.D.
[+] Author Affiliations

Read before the meeting of the Central Society for Clinical Research, Chicago, Nov. 6, 1936.

References concerning methods of analysis have been omitted from The Journal but will appear in the reprints.


ROCHESTER, MINN.

From the Division of Medicine, the Mayo Clinic.


JAMA. 1937;109(1):1-6. doi:10.1001/jama.1937.02780270003001
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Occasionally we observe patients with edema who do not present clinical evidence of the pathologic conditions that usually produce edema. They do not have nephritis, for the conditions ordinarily observed in nephritis are not present. Nor do they have hypertension, myocardial degeneration with congestive failure, cirrhosis, polyserositis, myxedema or a malignant growth. The patients are usually well nourished and have been accustomed to a well balanced diet. No evidence of infection or toxemia is found, but there is a history of gradual progressive edema over a period of months that does not respond to the usual therapeutic measures. Except for the edema the patient feels quite well and on first impression one would make a diagnosis of lipoid nephrosis.

On study, however, we find that there is no albumin in the urine; yet the value for serum protein is low, less than 5 Gm. per hundred cubic centimeters, and the

REFERENCES

Keith, N. M.:  General Edema of Indeterminate Origin , J. Clin. Investigation 11:832 ( (July) ) 1932;.
Thompson, W. H.; Ziegler, Mildred, and McQuarrie, Irvine:  A Comparative Study of the Inorganic Metabolism in Nephrosis and in Edema of Undetermined Origin , Am. J. Dis. Child. 44:650 ( (Sept.) ) 1932;.
Myers, W. K., and Taylor, F. H. L.:  Hypoproteinemia Probably Due to Deficient Formation of Plasma Proteins: A Study of One Case , J. A. M. A. 101: 198-200 ( (July 15) ) 1933;.
Drs. F. J. Hirschboeck, G. L. Berdez and F. W. Spicer of Duluth, Minn., sent the pathologic specimens, and Dr. H. E. Robertson gave his opinion regarding these specimens.
Epstein, A. A.:  Concerning the Causation of Edema in Chronic Parenchymatous Nephritis: Method for Its Alleviation , Am. J. M. Sc. 154:638-647 ( (Nov.) ) 1917;.
Frisch, R. A.; Mendel, L. B., and Peters, J. P.:  The Production of Edema and Serum Protein Deficiency in White Rats by Low Protein Diets , J. Biol. Chem. 84: 167-177 ( (Oct.) ) 1929;.
Jansen, W. H.:  Die Oedemkrankheit: Studien über die Physiologie der Unterernährung und über die Oedempathogenese , Deutsches Arch. f. klin. Med. 131:330-370 ( (March) ) 1920;.
Kohman, Emma A.:  The Experimental Production of Edema as Related to Protein Deficiency , Am. J. Physiol. 51:185-187 ( (Feb. 1) ) 1920;.
Bloomfield, A. R.:  The Effect of Carrot Feeding on the Serum Protein Concentration of the Rat , J. Exper. Med. 59:687-698 ( (June 1) ) 1934;.
Barker, M. H., and Kirk, E. J.:  Experimental Edema (Nephrosis) in Dogs in Relation to Edema of Renal Origin in Patients , Arch. Int. Med. 45:319-346 ( (March) ) 1930;.
Fahr, George; Kerkhof, Arthur, and Giere, Ellis:  Salt as a Factor in Edema Formation Following Plasmapheresis , Proc. Soc. Exper. Biol. & Med. 29:335-336 ( (Dec.) ) 1931;.
Leiter, Louis:  Experimental Edema , Proc. Soc. Exper. Biol. & Med. 26:173-175 ( (Nov.) ) 1928;.
Leiter, Louis;  Experimental Nephrotic Edema , Arch. Int. Med. 48: 1-32 ( (July) ) 1931;.
Shelburne, S. A., and Egloff, W. C.:  Experimental Edema , Arch. Int. Med. 48:51-69 ( (July) ) 1931;.
Holman, R. L.; Mahoney, E. B., and Whipple, G. H.:  Blood Plasma Protein Regeneration Controlled by Diet: I. Liver and Casein as Potent Diet Factors , J. Exper. Med. 59:251-267 ( (March) ) 1934;.
Weech, A. A.; Goettsch, E., and Reeves, E. B.:  The Effect of Serum Transfusion on the Plasma Protein Depletion Associated with Nutritional Edema in Dogs , J. Clin. Investigation 12:217-227 ( (Jan.) ) 1933;.
Hartmann, A. F., and Senn, M. J. E.:  Studies in Edema, with Particular Reference to the Therapeutic Value of Acacia , Am. J. Dis. Child. 44:673-674 ( (Sept.) ) 1932;.
Hartmann, A. F.; Senn, M. J. E.; Nelson, Martha V., and Perley, Anne M.:  The Use of Acacia in the Treatment of Edema , J. A. M. A. 100:251-254 ( (Jan. 28) ) 1933;.
Thompson, W. H.; McQuarrie, Irvine, and Bell, E. T.:  Edema Associated with Hypogenesis of Serum Proteins and Atrophic Changes in the Liver with Studies of the Water and Mineral Exchanges , J. Pediat. 9:604-619 ( (Nov.) ) 1936;
Stanbury, J. B.; Warweg, Edna, and Amberson, W. R.:  Total Plasmapheresis , Am. J. Physiol. 117:230-236 ( (Oct.) ) 1936;.
Nonnenbruch, W., and Kudlich, H.:  Chronischer Odemzustand von nephrotischen Typus mit Akropachie bei chronischer Gastroenteritis , Med. Klin. 27:541-545 ( (April 10) ) 1931;.
Cope, C. L., and Goadly, H. K.:  Study of a Case of an Idiopathic Hypoproteinaemia , Lancet 1: 1038-1040 ( (May 4) ) 1935;.

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Keith, N. M.:  General Edema of Indeterminate Origin , J. Clin. Investigation 11:832 ( (July) ) 1932;.
Thompson, W. H.; Ziegler, Mildred, and McQuarrie, Irvine:  A Comparative Study of the Inorganic Metabolism in Nephrosis and in Edema of Undetermined Origin , Am. J. Dis. Child. 44:650 ( (Sept.) ) 1932;.
Myers, W. K., and Taylor, F. H. L.:  Hypoproteinemia Probably Due to Deficient Formation of Plasma Proteins: A Study of One Case , J. A. M. A. 101: 198-200 ( (July 15) ) 1933;.
Drs. F. J. Hirschboeck, G. L. Berdez and F. W. Spicer of Duluth, Minn., sent the pathologic specimens, and Dr. H. E. Robertson gave his opinion regarding these specimens.
Epstein, A. A.:  Concerning the Causation of Edema in Chronic Parenchymatous Nephritis: Method for Its Alleviation , Am. J. M. Sc. 154:638-647 ( (Nov.) ) 1917;.
Frisch, R. A.; Mendel, L. B., and Peters, J. P.:  The Production of Edema and Serum Protein Deficiency in White Rats by Low Protein Diets , J. Biol. Chem. 84: 167-177 ( (Oct.) ) 1929;.
Jansen, W. H.:  Die Oedemkrankheit: Studien über die Physiologie der Unterernährung und über die Oedempathogenese , Deutsches Arch. f. klin. Med. 131:330-370 ( (March) ) 1920;.
Kohman, Emma A.:  The Experimental Production of Edema as Related to Protein Deficiency , Am. J. Physiol. 51:185-187 ( (Feb. 1) ) 1920;.
Bloomfield, A. R.:  The Effect of Carrot Feeding on the Serum Protein Concentration of the Rat , J. Exper. Med. 59:687-698 ( (June 1) ) 1934;.
Barker, M. H., and Kirk, E. J.:  Experimental Edema (Nephrosis) in Dogs in Relation to Edema of Renal Origin in Patients , Arch. Int. Med. 45:319-346 ( (March) ) 1930;.
Fahr, George; Kerkhof, Arthur, and Giere, Ellis:  Salt as a Factor in Edema Formation Following Plasmapheresis , Proc. Soc. Exper. Biol. & Med. 29:335-336 ( (Dec.) ) 1931;.
Leiter, Louis:  Experimental Edema , Proc. Soc. Exper. Biol. & Med. 26:173-175 ( (Nov.) ) 1928;.
Leiter, Louis;  Experimental Nephrotic Edema , Arch. Int. Med. 48: 1-32 ( (July) ) 1931;.
Shelburne, S. A., and Egloff, W. C.:  Experimental Edema , Arch. Int. Med. 48:51-69 ( (July) ) 1931;.
Holman, R. L.; Mahoney, E. B., and Whipple, G. H.:  Blood Plasma Protein Regeneration Controlled by Diet: I. Liver and Casein as Potent Diet Factors , J. Exper. Med. 59:251-267 ( (March) ) 1934;.
Weech, A. A.; Goettsch, E., and Reeves, E. B.:  The Effect of Serum Transfusion on the Plasma Protein Depletion Associated with Nutritional Edema in Dogs , J. Clin. Investigation 12:217-227 ( (Jan.) ) 1933;.
Hartmann, A. F., and Senn, M. J. E.:  Studies in Edema, with Particular Reference to the Therapeutic Value of Acacia , Am. J. Dis. Child. 44:673-674 ( (Sept.) ) 1932;.
Hartmann, A. F.; Senn, M. J. E.; Nelson, Martha V., and Perley, Anne M.:  The Use of Acacia in the Treatment of Edema , J. A. M. A. 100:251-254 ( (Jan. 28) ) 1933;.
Thompson, W. H.; McQuarrie, Irvine, and Bell, E. T.:  Edema Associated with Hypogenesis of Serum Proteins and Atrophic Changes in the Liver with Studies of the Water and Mineral Exchanges , J. Pediat. 9:604-619 ( (Nov.) ) 1936;
Stanbury, J. B.; Warweg, Edna, and Amberson, W. R.:  Total Plasmapheresis , Am. J. Physiol. 117:230-236 ( (Oct.) ) 1936;.
Nonnenbruch, W., and Kudlich, H.:  Chronischer Odemzustand von nephrotischen Typus mit Akropachie bei chronischer Gastroenteritis , Med. Klin. 27:541-545 ( (April 10) ) 1931;.
Cope, C. L., and Goadly, H. K.:  Study of a Case of an Idiopathic Hypoproteinaemia , Lancet 1: 1038-1040 ( (May 4) ) 1935;.
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