A CRITIQUE OF THE OVERFILL HYPOTHESIS OF SODIUM AND WATER-RETENTION IN THE NEPHROTIC SYNDROME

Recent reviews have claimed that the majority of patients with the nep hrotic syndrome have plasma volume expansion (that is, they are overfi lled). Here we attempt to re-establish balance to the debate on body f luid volume status in nephrotic patients by: (a) discussing the confli cting literature on plasma volume measurements in the nephrotic syndro me; (b) providing alternate explanations for data purporting to suppor t an overfill hypothesis in the nephrotic syndrome; (c) emphasizing se condary neurohumoral responses that support underfilling at least as f requently as overfilling; and (d) emphasizing the clinical importance of fluid assessment in the individual patient with the nephrotic syndr ome particularly in relation to diuretic use.