Stepwise Interpretation of Albumin Fraction Abnormalities on Serum Protein Capillary Electrophoresis in Nephrotic Syndrome: A Case Series
DOI:
https://doi.org/10.61882/ijkd.20.02.9386Keywords:
Albumin, Capillary electrophoresis, Multiple myeloma, Nephrotic syndrome, Serum proteinsAbstract
Serum protein electrophoresis (SPEP) is commonly used in the diagnostic evaluation of nephrotic syndrome (NS) to rule out monoclonal gammopathies. However, NS itself and various other factors may cause transient bisalbuminemia, resulting in albumin fraction irregularities in capillary SPEP and complicating interpretation. This study proposes a stepwise approach for interpreting albumin fraction irregularities, illustrated through three representative cases of NS.
Case 1: a 44-year-old woman with isolated proteinuria, Case 2: a 36-year-old woman with diabetic foot infection, and Case 3: a 58-year-old man with ankylosing spondylitis, all presenting with nephrotic-range proteinuria. On initial SPEP case 1 exhibited a distinct sharp peak, while cases 2 and 3 showed irregular bands between the albumin and α1 regions. A stepwise interpretative approach was applied: First, technical errors were excluded by repeat analysis using alternative capillaries on the same analyzer. Second, potential biochemical interferences were evaluated. Third, SPEP was repeated using freshly collected samples. Fourth, persistent albumin fraction irregularities prompted consideration of biochemical albumin modifications, such as glycosylated or carbamylated forms. Fifth, other causes including drugs, heavy metal toxicity, liver disease, and systemic inflammation were excluded. Finally, additional tests such as immunofixation electrophoresis were performed to rule out monoclonal proteins. In the absence of monoclonal proteins, the condition was interpreted as bisalbuminemia related to NS. Using this approach, transient bisalbuminemia was considered the most likely cause in Cases 1 and 2, whereas the disappearance of the irregular band in Case 3 suggested a preanalytical artifact. Systematic interpretation of albumin fraction irregularities can help distinguish true pathology from benign or artifactual patterns in patients with NS.
Downloads
References
1. Lefrère B, Dedôme E, Garcia-Hejl C, Ragot C, Chianea D, Delacour H, et al. Bisalbuminemia: A case report. Rev Med Interne. 2018;39(12):950-4.
2. Faviou E, Nounopoulos C, Dionyssiou-Asteriou A. Bisalbuminemia from a clinical chemist’s viewpoint: a case report and review of the recent literature. Minerva Med. 2006;97:287-93.
3. Kobayashi S, Okamura N, Kamoi K, Sugita O, Kamoi K. Bisalbumin (fast and slow type) induced by human pancreatic juice. Ann Clin Biochem. 1995;32:63-7.
4. Badr H, Young PE, Dong J, et al. Combined bisalbuminemia and bisalbuminuria: a rare finding
on serum and urine electrophoresis. Clin Chim Acta. 2024;552:117635.
5. Hoang MP, Baskin LB, Wians FH Jr. Bisalbuminuria in an adult with bisalbuminemia and nephrotic syndrome. Clin Chim Acta. 1999;284:101-7.
6. Mendler MH, Corbinais S, Sapey T, et al. In patients with cirrhosis, serum albumin determination should
be carried out by immunonephelometry rather than by protein electrophoresis. Eur J Gastroenterol Hepatol. 1999;11:1405-11.
7. Regeniter A, Siede WH. Peaks and tails: evaluation of irregularities in capillary serum protein electrophoresis. Clin Biochem. 2018;51:48-55.
8. Arvan DA, Blumberg BS, Melartin L. Transient “bisalbuminemia” induced by drugs. Clin Chim Acta. 1968;22:211-8.
9. Ogawa M, Toda N, Kurahashi S, et al. Bisalbuminemia in nephrotic syndrome. Kidney Int. 2022;102:943.
10. Favresse J, Delanghe J. High-resolution capillary electrophoresis for the determination of carbamylated albumin. Clin Chem Lab Med. 2022;60(2):229-34.
11. Hellara I, Fekih O, Triki S, Elmay A, Neffati F, Najjar MF. Does bilirubin interfere with capillary electrophoresis of serum proteins? Ann Biol Clin (Paris). 2017;72:124-8.
12. Bagade S, Anjum A. Bisalbuminemia: A rare incidental finding in monoclonal gammopathy. EJIFCC.2023;34(4):325-9.
13. Şeneş M, Alpdemir M, Kırtıl G, Öğüş E, Çolak Samsum E, Alpdemir MF. Effects of lipemia on capillary serum protein electrophoresis in native ultra-lipemic material and intravenous lipid emulsion added sera. Clin Chem Lab Med. 2022;61:1054-64.
14. Schneider W. “Albuminplasmocytoma” – a rare paper electrophoretic finding of a myeloma. Arztl Forsch. 1967;21(10):382-4.
15. Akhmouch I, Alayoud A, Bahadi A, et al. Bisalbuminemia during remission of nephrotic syndrome. Saudi J Kidney Dis Transpl. 2012;23(6):1251-3.
16. Ghosh A, Chowdhury N. An unusual case of bisalbuminemia in a 61-year-old male patient.
2025;121:60-1.
17. Lee P, Wu X. Modifications of human serum albumin and their binding effect. Curr Pharm Des. 2015;21.
18. Vladutiu AO. Faster electrophoretic mobility of albumin in diabetes. JAMA. 1980;244(1):27-8.
19. Gross ML, Piecha G, Bierhaus A, et al. Glycated and carbamylated albumin are more “nephrotoxic” than unmodified albumin in the amphibian kidney. Am J Physiol Renal Physiol. 2011;301(3):F476-85.
20. Mehta A, Shenoy R, BS D, Mundkur S, Biswas M. Electrophoretic pattern of serum and urinary proteins in nephrotic syndrome. Biomedicine. 2022;42:478-83.
21. Cakirca G, Guzelcicek A, Yilmaz K, Nas C. Increased ischemia-modified albumin levels in children with steroid-sensitive nephrotic syndrome. Pak J Med Sci. 2020;36(7).
22. Haeri HH, Eisermann J, Schimm H, et al. Profound changes in functional structure and dynamics of serum albumin in children with nephrotic syndrome: an exploratory research study. J Med Chem. 2023;66(17):12115-29.
23. Hadrach S. Bisalbuminemias caused by betalactamine antibiotic and nephrotic syndrome: case report. J Clin Case Stud Rev Rep. 2024;1:1-6.
24. Jaeggi-Groisman S, Byland CGH, Gerber H. Improved sensitivity of capillary electrophoresis for detection of bisalbuminemia. Clin Chem. 2000;46:882-3.
25. Levey AS, Stevens LA, Schmid CH, et al. Estimating GFR using the CKD-EPI creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55:622-7.
Downloads
Published
Data Availability Statement
All research data are presented in the article.
