Clin Kidney J (2012) 5: 607 doi: 10.1093/ckj/sfs136 Advance Access publication 17 October 2012
Images in Nephrology
(Section Editor: G. H. Neild) Serum electrophoresis with a bifid albumin peak Sutirtha Chakraborty1, Saubhik Sural2 and Susruta Sen3 1
Department of Biochemistry, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India, 2Department of Nephrology, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India and 3Department of Biochemistry, Calcutta Medical Research Institute, Kolkata, West Bengal, India Correspondence and offprint requests to: Sutirtha Chakraborty; E-mail: [email protected], [email protected]
A 51-year old female patient with newly diagnosed chronic kidney disease (CKD) presented to the hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD). On admission her serum creatinine was 247 µmol/L and urea was 15 mmol/L. The patient
was a known hypertensive and was on irregular treatment. The CKD was probably a result of hypertensive nephropathy. As the liver function test showed a reversal of the albumin globulin ratio, a serum protein electrophoresis was requested. The overall electrophoresis was normal, except that the gamma globulin was elevated and a bifid peak was seen in the albumin region. The electrophoretic pattern of serum in Figure 1 shows that the albumin peak has a bifid mountain where albumin has two heads; this condition is commonly known as Bisalbuminemia. It is a result of two types of serum albumin that differ in their electrophoretic mobility as a result of splitting of the serum albumin into two components, of which one represents a variant on account of genetically inherited or acquired determinant [1]. Bisalbuminemia is of two types, genetic and acquired. Genetic bisalbuminemia is quite rare and is inherited in autosomal dominant form. Bisalbuminemia is of little diagnostic or therapeutic significance, except that in some cases it might result in altered binding of steroid hormones and thyroxine. Familial dysalbuminemic hyperthyroxinemia (Arg 218 AEHis and Arg 218 AE Pro mutations) and hypertriiodothyroninemia (Leu 66 AEPro mutation) have been directly linked to the presence of inherited bisalbuminemia [2]. The acquired type may result from long-term, aggressive beta lactam antibiotic therapy or in acute pancreatitis. Physicians should be aware of this condition and interpret such findings with caution as well as in the context of the clinical scenario. Conflict of interest statement. None declared.
References 1. Thakar YS, Chande C, Dhanvijay AG et al. Bisalbuminemia: An interesting electrophoretic abnormality- A report of two cases. Indian J Pathol Microbiol 1997; 40: 559–561 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: 287–293 Fig. 1. The top serum protein electrophoresis shows the presence of bisalbuminemia. Below is a normal serum protein electrophoresis.
Received for publication: 11.8.12; Accepted in revised form: 24.8.12
© The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: [email protected].
Downloaded from http://ckj.oxfordjournals.org/ at East Carolina University on April 23, 2015
Keywords: bisalbuminemia; serum electrophoresis
Images in Nephrology
(Section Editor: G. H. Neild) Serum electrophoresis with a bifid albumin peak Sutirtha Chakraborty1, Saubhik Sural2 and Susruta Sen3 1
Department of Biochemistry, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India, 2Department of Nephrology, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India and 3Department of Biochemistry, Calcutta Medical Research Institute, Kolkata, West Bengal, India Correspondence and offprint requests to: Sutirtha Chakraborty; E-mail: [email protected], [email protected]
A 51-year old female patient with newly diagnosed chronic kidney disease (CKD) presented to the hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD). On admission her serum creatinine was 247 µmol/L and urea was 15 mmol/L. The patient
was a known hypertensive and was on irregular treatment. The CKD was probably a result of hypertensive nephropathy. As the liver function test showed a reversal of the albumin globulin ratio, a serum protein electrophoresis was requested. The overall electrophoresis was normal, except that the gamma globulin was elevated and a bifid peak was seen in the albumin region. The electrophoretic pattern of serum in Figure 1 shows that the albumin peak has a bifid mountain where albumin has two heads; this condition is commonly known as Bisalbuminemia. It is a result of two types of serum albumin that differ in their electrophoretic mobility as a result of splitting of the serum albumin into two components, of which one represents a variant on account of genetically inherited or acquired determinant [1]. Bisalbuminemia is of two types, genetic and acquired. Genetic bisalbuminemia is quite rare and is inherited in autosomal dominant form. Bisalbuminemia is of little diagnostic or therapeutic significance, except that in some cases it might result in altered binding of steroid hormones and thyroxine. Familial dysalbuminemic hyperthyroxinemia (Arg 218 AEHis and Arg 218 AE Pro mutations) and hypertriiodothyroninemia (Leu 66 AEPro mutation) have been directly linked to the presence of inherited bisalbuminemia [2]. The acquired type may result from long-term, aggressive beta lactam antibiotic therapy or in acute pancreatitis. Physicians should be aware of this condition and interpret such findings with caution as well as in the context of the clinical scenario. Conflict of interest statement. None declared.
References 1. Thakar YS, Chande C, Dhanvijay AG et al. Bisalbuminemia: An interesting electrophoretic abnormality- A report of two cases. Indian J Pathol Microbiol 1997; 40: 559–561 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: 287–293 Fig. 1. The top serum protein electrophoresis shows the presence of bisalbuminemia. Below is a normal serum protein electrophoresis.
Received for publication: 11.8.12; Accepted in revised form: 24.8.12
© The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: [email protected].
Downloaded from http://ckj.oxfordjournals.org/ at East Carolina University on April 23, 2015
Keywords: bisalbuminemia; serum electrophoresis
