Question

Which of the following causes decrease in albumin/globulin (A/G) ratio?
A. Glomerular Nephritis
B. Gastro-intestinal parasitism
C. Exocrine Pancreatic Insufficiency
D. Acute Inflammation
E. Pregnancy toxemia
F. Congestive heart failure
Choose the correct answer from the options given below:

• A. A, B, C and D only
• B. B, C, D and E only
• C. A, C, D and E only
• D. C, D, E and F only

Hint:

A low A/G ratio is commonly due to either hypoalbuminemia (from renal loss, gut loss, or liver failure) or hyperglobulinemia (from chronic inflammation or immune stimulation).

Answer 1

The Correct Option is A

Step 1: Understanding the Concept:
Total serum protein consists of two main fractions: albumin and globulins.
The Albumin/Globulin (A/G) ratio is a clinical metric where a decrease can result from a drop in albumin, an increase in globulins, or both.

Step 2: Detailed Explanation:
Let us analyze the physiological effects of the listed conditions:
A. Glomerular Nephritis: Leads to glomerular damage, allowing albumin (which is smaller than globulins) to pass into the filtrate, resulting in selective albuminuria and hypoalbuminemia, which decreases the A/G ratio.
B. Gastro-intestinal parasitism: Causes a protein-losing enteropathy due to mucosal damage, leading to loss of plasma proteins (especially albumin), lowering the A/G ratio.
C. Exocrine Pancreatic Insufficiency (EPI): Leads to maldigestion and malabsorption of dietary proteins, reducing the amino acid pool available for hepatic albumin synthesis, resulting in hypoalbuminemia and a decreased A/G ratio.
D. Acute Inflammation: Promotes the hepatic synthesis of positive acute-phase proteins (globulins) while downregulating albumin synthesis (which acts as a negative acute-phase protein), decreasing the A/G ratio.
Conversely, pregnancy toxemia (E) and congestive heart failure (F) do not typically cause a primary, selective decrease in the A/G ratio.
Thus, conditions A, B, C, and D are established causes of a decreased A/G ratio.

Step 3: Final Answer:
The conditions that cause a decrease in the albumin/globulin ratio are Glomerular Nephritis, Gastro-intestinal parasitism, Exocrine Pancreatic Insufficiency, and Acute Inflammation (A, B, C and D only).