Decreased albumin with increased a1 and a2 is most associated with which condition according to the material?

• A. Nephrotic syndrome
• B. Hepatic cirrhosis
• C. Chronic infection
• D. Protein losing enteropathy

Answer: (A)

When albumin is down but the alpha-1 and alpha-2 globulin fractions are up, it points to nephrotic syndrome. In nephrotic syndrome there is heavy loss of protein in the urine, especially albumin, which drops the plasma albumin level and lowers oncotic pressure. In response, the liver ramps up production of various plasma proteins, including several alpha-globulin acute-phase proteins, so the alpha-1 and alpha-2 fractions rise on protein analysis.

This pattern helps distinguish nephrotic syndrome from other conditions. Cirrhosis also lowers albumin due to reduced synthesis, but the rise in alpha-1 and alpha-2 globulins isn’t a characteristic feature there, and chronic infection tends to elevate gamma globulins from increased antibody production. Protein-losing enteropathy reduces many proteins, including immunoglobulins, rather than causing a selective rise in alpha fractions. So the combination of low albumin with increased alpha-1 and alpha-2 globulins best fits nephrotic syndrome.