الفهرس 
Physiology of AlbuminOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
Albumin is an important molecule under physiological and pathophysiological conditions, with multiple effects, including regulation of osmotic pressure; carrier of poorly water soluble molecules ,such as hormones, cholesterol, calcium, iron, bilirubin, free fatty acids, and drugs; and anti-oxidant properties.
Human albumin (HA) is the most expensive non-blood plasma substitute used to treat hypovolaemia. HA is also used in many centres to correct hypoalbuminaemia. The role of HA is, however, still controversial and its use may be based more on custom than on a scientific basis. Because of its limited availability and high cost, it is imperative that the use of HA is restricted to indications for which it is efficacious. The arguments over its pros and cons are long-standing. Some meta-analyses that have tried to clarify the place of HA have resulted in widely divergent conclusion.
Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect.
Albumin has neuroprotective properties. It appears to have anti-oxidant characteristics and direct effects on vascular endothelial permeability.
Recent trials reported successful resuscitation including albumin in the early post burn period with decreased volume requirements and low weight gain compared with pure crystalloid resuscitation.
It is now evident and quite well accepted that, apart from its oncotic properties, albumin has secondary functions that may play a critical role and have a great impact on different types of diseases. One of the most important categories of patients for which preliminary results suggest a potential beneficial role of albumin on outcome is that of patients with severe sepsis.
Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.