An 81-year-old man presented to the Nutrition Unit of Internal Medicine for hypoproteinemia study.
His personal history included hypertension, cardiac arrhythmia due to atrial fibrillation with adequate ventricular response.
Echocardiography showed moderate mitral regurgitation, moderate aortic regurgitation due to valve annuloectasia and atrial dilatation without pulmonary hypertension.
He also reported Paget's disease of the bone, which is currently inactive.
Monorrenus due to hypoplasia of the contralateral kidney.
She had been operated on for gastric ulcus 50 years ago. A subtotal gastrectomy was performed Billroth type I (multiple endoscopy), which aimed at surgical resection and chronic atrophic gastritis of the stump.
The patient was reviewed by the Nephrology Department due to her renal disease, with no significant proteinuria.
Right hepatic profile.
In the anamnesis, the patient reported good appetite and adequate intake, performing a balanced diet.
Conserved depositional habit.
Physical examination revealed edema in both lower extremities and BMI contaminated with 2 kg/m2.
In the analytical, hypoalbuminemia 2.002 mg/dl. Treatment with home enteral nutrition hyperproteic is initiated.
In the following control, albumin decreased to 1,930 mg/dl because it is thought of a malaractive disease despite not reporting diarrhea symptoms.
D-xylosa and Van de la Ka, both negative, were performed.
The presence of celiac disease was ruled out and a normal gastroduodenal study was performed.
Subcutaneous fat biopsy does not reflect amyloidosis.
diagnosed with protein-losing disease, clearance of A1AT is performed in faeces with a value of 218 ml/day (> 24 ml/day) [A1AT in blood: 156 mg/dL; A1AT in faeces:
Despite not observing another underlying cause, it is not possible to ensure that its cardiac alteration is the basis of PLE.
In treatment with home enteral nutrition, maintains stable albumin levels.
