Observations on edema formation and resolution in Gleich syndrome: Essential role of the kidneys in effective arterial blood volume regulation

Gleich syndrome is clinically present with episodes of angioedema, hypereos inophilia, oliguria, and weight gain due to fluid retention which may be su dden and remarkable, sometimes increasing to 10-20% of the baseline weight. The purpose of this study was to evaluate body fluid regulation and hormon al responses during the episode of angioedema and during the recovery phase in a patient with Gleich syndrome. A 24-year-old male was referred to our hospital for further evaluation of recurrent attacks of swellings of face, upper arms, and legs, marked weight gain, and oliguria. On first admission, the patient was in a remission phase, and the initial physical examination showed no abnormalities. Underlying disorders causing edema, such as heart , kidney, and liver diseases, and the recognized causes for hypereosinophil ia, such as allergy, parasites, and collagen diseases, were ruled out. Afte r 2 months, since his course was monitored, the patient was hospitalized. D uring days 10-19, he developed pronounced nonpitting edema of face, upper a rms, and legs. Constant leukocytosis and hypereosinophilia, oliguria, and m arked weight gain were also noted. A clinical remission was observed withou t any medication: intensive diuresis, loss of weight, regression of edema, and decreased eosinophil and leukocyte counts within 2 weeks. Physiological mechanisms during edema and resolution are discussed. In conclusion, our p atient represents a suitable model for the protection of effective arterial blood volume because of the absence of underlying disorders causing edema. The kidneys play an essential role in the effective arterial blood volume regulation. Copyright (C) 2001 S. KargerAG, Basel.