23. Diskin, C.J.; Gupta, Ram B.; Ravis, W.R.; Stokes, T.J.; Dansby, L.M.; Carter, T.B. Edema, Oncotic Pressure and Entropy: Novel Considerations for the Treatment of Edema Through Attention to Thermodynamics. Nephron (1998) 78, 131-138.
Abstract
Over 170 years after Richard
Bright and a century after Ernest H.
Starling, the development, location, and severity of edema in patients
with renal impairment continue to baffle the predictions of most
nephrologists. While much of the
phenomenon can be explained by levels of serum proteins, or hydrostatic
pressures, there are stunning exceptions well known to any practicing nephrologist. Some of the derangement is undoubtedly due to
unmeasured but well-known variables, such as membrane permeability; however,
other factors such as free entropy of plasma are also clearly involved. The study of other polyelectrolyte colloids,
similar to plasma proteins, for industrial purposes has led to the
identification of various phenomena such as counterion
condensation that can result in loss of entropy and consequently osmotic
pressure. Variables known to result in a
loss of free entropy, such as pH, oxidation products and ligand
binding, are discussed. Older equations
developed by van't Hoff and Donnan
might require replacement by newer mathematical models such as the nonlinear
Poisson-Boltzmann equation or the
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