Lab result explainedLiverLast updated November 8, 2026

Albumin blood test: what low and high serum albumin levels mean

Albumin (serum) · Comprehensive metabolic panel (CMP), liver (hepatic) panel · reported in g/dL (g/L outside the US; 1 g/dL = 10 g/L)

Albumin is the most abundant protein in your blood, making up about 60 percent of the total protein. Your liver produces it, roughly 10 to 15 grams a day, and it does two main jobs: it holds fluid inside blood vessels (it provides about three-quarters of the pulling pressure that keeps plasma from leaking into tissues), and it carries hormones, calcium, bilirubin, fatty acids and many drugs around the body. A normal serum albumin is about 3.5 to 5.0 g/dL in adults; some labs use 3.4 to 5.4.

Low albumin, called hypoalbuminemia, is the result that matters. It is common in hospital and has four broad causes: the liver is not making enough (cirrhosis, advanced liver disease), albumin is being lost (through the kidneys in nephrotic syndrome, through the gut, through burned skin), inflammation is switching production off and shifting albumin out of the bloodstream (any significant infection, surgery, cancer or chronic inflammatory disease), or intake is too poor to supply the raw materials (malnutrition). Of these, inflammation is the single most common reason for a low albumin in someone who is unwell.

Albumin has a half-life of about three weeks, so it changes slowly and reflects the past month rather than today. Mild reductions (3.0 to 3.4 g/dL) are often found with chronic illness, older age or pregnancy and cause no symptoms. Below about 2.5 g/dL, fluid starts to leak into tissues, causing swollen ankles, a swollen abdomen or puffy eyes. A high albumin is almost always a sign of dehydration rather than disease, and corrects itself with fluids.

Albumin (serum) at a glance

  • What it is: the main protein in blood plasma, made by the liver; keeps fluid in the blood vessels and transports hormones, calcium, bilirubin and drugs.
  • Normal: 3.5–5.0 g/dL in adults (35–50 g/L; some labs 3.4–5.4). Falls by up to 1 g/dL in late pregnancy and slightly with age.
  • Low (hypoalbuminemia): below 3.5 g/dL. Mild 3.0–3.4, moderate 2.5–2.9, severe below 2.5. Causes: inflammation or infection, liver disease, kidney protein loss, gut loss, malnutrition, heart failure.
  • High: above 5.0 g/dL, almost always dehydration or a prolonged tourniquet during the blood draw; not a sign of disease in itself.
  • Swelling (edema, ascites) appears as albumin falls below about 2.5 g/dL; below 3.0 before surgery, complications and mortality rise.
  • Next step: read with CRP, liver tests, creatinine and a urine protein test to find which of the four mechanisms is responsible; treat the cause, as albumin cannot be raised directly by eating more protein if inflammation is driving it down.

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What Albumin (serum) measures

Albumin is a single protein of 585 amino acids made only by liver cells and released straight into the blood. About 40 percent of the body's albumin is in the bloodstream at any time and the rest is in the fluid between cells, with the two pools exchanging continuously. Because it is small, abundant and negatively charged, albumin generates most of the oncotic (colloid osmotic) pressure that pulls water back into capillaries, which is why low levels lead to swelling. It also binds and carries calcium (about 40 percent of blood calcium is albumin-bound), unconjugated bilirubin, thyroid and steroid hormones, fatty acids, and drugs such as warfarin and phenytoin.

The lab measures albumin with a dye-binding method (bromocresol green or bromocresol purple) on the same sample as the rest of the metabolic panel. The two dyes give slightly different results, with bromocresol green reading about 0.3 to 0.5 g/dL higher in people with low albumin and kidney disease, which partly explains differences between labs. Albumin is also measured as part of total protein, and total protein minus albumin gives the globulin fraction.

Several non-disease factors shift the value. Albumin is about 0.3 to 0.5 g/dL lower when blood is drawn lying down than standing, because fluid moves into the bloodstream; it falls by 0.5 to 1 g/dL during pregnancy as blood volume expands; and it drops acutely by 0.5 g/dL or more within a day of surgery, trauma or severe infection as capillaries become leaky and the liver switches production toward inflammatory proteins. A long tourniquet time or dehydration concentrates it upward. Albumin is not a fasting test.

Normal range for Albumin (serum)

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (g/dL (g/L outside the US; 1 g/dL = 10 g/L))Notes
Adults, normal3.5–5.0 g/dLSome labs use 3.4–5.4 or 3.8–4.8 g/dL. Equivalent to 35–50 g/L. Labs differ; use the printed range.
Children3.8–5.4 g/dLNewborns run lower (2.8–4.4 g/dL) for the first weeks.
Adults over 70About 3.2–4.8 g/dLFalls roughly 0.1 g/dL per decade after 60; a value of 3.3 in a healthy 85-year-old is common.
PregnancyAbout 2.5–4.0 g/dL by the third trimesterBlood volume rises 40–50 percent, diluting albumin; this is normal and resolves after delivery.
Mild hypoalbuminemia3.0–3.4 g/dLChronic inflammation, early liver or kidney disease, older age, heart failure. Usually no symptoms.
Moderate hypoalbuminemia2.5–2.9 g/dLSignificant illness, cirrhosis, nephrotic syndrome, protein-losing gut disease or malnutrition; swelling may begin. Below 3.0 before surgery increases complication risk.
Severe hypoalbuminemiaBelow 2.5 g/dLEdema and ascites are expected; typical of nephrotic syndrome, decompensated cirrhosis, severe burns, sepsis or advanced malnutrition. Below 2.0 is associated with high mortality in hospital.
HighAbove 5.0 g/dLDehydration or hemoconcentration from a prolonged tourniquet; rarely from very high protein intake. No disease causes a genuinely raised albumin.

High albumin

A high albumin is almost never a disease. The liver does not overproduce albumin, so a value above 5.0 g/dL means the blood has become concentrated: you were dehydrated when the sample was taken, or the tourniquet was on for several minutes, which squeezes fluid out of the vessels in the arm and concentrates the proteins. Vomiting, diarrhoea, heavy sweating, diuretics and simply not drinking enough are the usual culprits, and the hematocrit, sodium and BUN are often slightly high too.

Values of 5.1 to 5.5 g/dL in a well-hydrated, healthy person are seen occasionally and are usually within the natural variation of the assay or a reflection of a high-protein diet and vigorous exercise. There is no upper level of albumin that causes symptoms or needs treatment. A repeat test after drinking normally, with a short tourniquet time, is the only follow-up needed, and in practice most clinicians simply note it.

Very rarely, a high reading comes from analytical interference, for example in some people receiving intravenous immunoglobulin or with unusual paraproteins that bind the dye. If total protein is also high, the globulin fraction and a protein electrophoresis are more informative than the albumin itself.

Common causes

  1. Dehydration

    Loss of water from vomiting, diarrhoea, fever, exercise, diuretics or low fluid intake concentrates albumin, typically raising it by 0.3 to 0.8 g/dL; it returns to baseline with rehydration.

  2. Prolonged tourniquet or fist clenching during the blood draw

    Venous stasis for more than a minute or two pushes plasma water into the tissues of the arm and raises albumin and other proteins by up to 10 percent.

  3. Standing versus lying position

    Samples taken after standing read 0.3 to 0.5 g/dL higher than those taken after lying down, because gravity shifts fluid out of the bloodstream.

  4. High-protein diet and anabolic steroids

    Both nudge albumin toward the upper end of normal but do not produce clinically significant elevation.

  5. Laboratory interference

    Some paraproteins, lipemic samples and intravenous immunoglobulin can interfere with dye-binding assays and give a spuriously high or low result; a repeat or a different method resolves it.

  6. Hemoconcentration in burns or shock (early)

    In the first hours after a major burn, plasma leaks out faster than albumin, transiently raising the concentration before it falls sharply.

Symptoms that can go with it

  • None from the albumin itself
  • Thirst, dry mouth, dark urine, dizziness on standing or headache if dehydration is the cause
  • Reduced skin elasticity and fatigue with more significant fluid loss

Low albumin (hypoalbuminemia)

A low albumin tells you that one of four things is happening: the liver is making less, albumin is leaking out of the body, inflammation is redistributing and suppressing it, or there are not enough amino acids coming in to build it. In practice, inflammation is the commonest reason. Any significant infection, surgery, injury, cancer or active inflammatory disease makes capillaries leaky, so albumin moves out of the bloodstream into the tissues, while the liver switches its output toward acute-phase proteins such as CRP. Albumin can fall by 1 g/dL or more within a few days of becoming seriously unwell, and a low albumin with a high CRP is a marker of how sick someone is rather than of nutrition.

When CRP is normal, the other mechanisms come to the front. In cirrhosis and other advanced liver disease, the liver simply cannot make enough; albumin below 3.5 g/dL is one of the criteria used to stage cirrhosis (Child-Pugh), and below 2.8 marks advanced disease. In nephrotic syndrome, damaged kidney filters leak more than 3.5 g of protein a day into the urine and albumin typically falls below 3.0 g/dL, with frothy urine and swelling. Protein-losing enteropathy (celiac disease, inflammatory bowel disease, intestinal lymphangiectasia) loses albumin through the gut; extensive burns lose it through skin. Poor intake lowers albumin slowly, over weeks to months, and rarely below 3.0 g/dL on its own unless starvation is severe.

The level matters for two practical reasons. Below about 2.5 g/dL, oncotic pressure can no longer hold fluid in the vessels and edema or ascites develop. And because albumin binds calcium and many drugs, a low albumin makes total calcium read falsely low (corrected calcium = measured calcium + 0.8 × (4.0 − albumin)) and increases the free, active fraction of drugs such as phenytoin and warfarin. A pre-operative albumin below 3.0 g/dL is one of the strongest single predictors of surgical complications: in a study of over 54,000 US veterans, 30-day mortality rose from under 1 percent at albumin above 4.6 to 29 percent below 2.1 g/dL.

Common causes

  1. Acute or chronic inflammation and infection

    The most common cause in hospital. Interleukin-6 and TNF make capillaries leaky and suppress liver albumin synthesis by up to half; pneumonia, sepsis, surgery, trauma, active rheumatoid arthritis, inflammatory bowel disease and cancer all lower albumin, often by 0.5–1.5 g/dL, with a raised CRP.

  2. Liver cirrhosis and chronic liver disease

    Fewer functioning liver cells and portal hypertension reduce synthesis; albumin under 3.5 g/dL contributes to Child-Pugh class B, under 2.8 to class C. Alcohol, viral hepatitis and fatty liver disease are the usual underlying causes.

  3. Nephrotic syndrome and other kidney protein loss

    Urinary protein above 3.5 g/day from diabetic kidney disease, minimal change disease, membranous nephropathy, FSGS or lupus nephritis lowers albumin to 2.0–3.0 g/dL, with swelling, high cholesterol and frothy urine.

  4. Protein-losing enteropathy

    Untreated celiac disease, Crohn's disease, ulcerative colitis, intestinal lymphangiectasia, severe heart failure affecting the gut and some infections leak albumin into the bowel; stool alpha-1 antitrypsin confirms it.

  5. Malnutrition and inadequate protein intake

    Anorexia nervosa, alcohol dependence, advanced cancer, frailty in older adults and prolonged poor appetite reduce the amino acids available; albumin falls slowly and is usually accompanied by low prealbumin, weight loss and muscle wasting.

  6. Heart failure

    Congestion of the liver and gut, dilution from fluid retention and low-grade inflammation lower albumin in about a third of people with chronic heart failure; a low albumin predicts worse outcomes.

  7. Burns, wounds and skin disease

    Extensive burns, large chronic wounds and widespread exfoliative skin disease lose albumin directly through damaged skin and drive a strong inflammatory response.

  8. Overhydration and dilution

    Large volumes of intravenous fluid, fluid retention from kidney failure or SIADH and the expanded blood volume of pregnancy dilute albumin by 0.5–1.0 g/dL without any change in the body's total albumin.

  9. Hyperthyroidism, Cushing's syndrome and corticosteroids

    Increase protein breakdown and albumin turnover, lowering it modestly.

  10. Rare inherited analbuminemia

    A handful of people worldwide make almost no albumin and are surprisingly well, with only mild swelling and high cholesterol, because other proteins partly compensate.

Symptoms that can go with it

  • Often none when albumin is 3.0–3.4 g/dL
  • Swelling of the ankles, feet and lower legs that leaves a dent when pressed (pitting edema)
  • Puffiness around the eyes, especially in the morning, with kidney protein loss
  • A swollen abdomen from fluid (ascites) in liver disease or nephrotic syndrome
  • Frothy or foamy urine when protein is being lost through the kidneys
  • Fatigue, muscle weakness and loss of muscle bulk
  • Poor appetite, weight loss, brittle hair or slow wound healing when malnutrition contributes
  • Shortness of breath from fluid around the lungs (pleural effusion) at very low levels

Read it alongside

  • CRP — a high CRP with a low albumin means inflammation is the driver; a low albumin with a normal CRP points to liver disease, kidney or gut loss, or intake.
  • Total protein and globulin — a low albumin with a normal or high total protein suggests a raised globulin (chronic infection, autoimmune disease, myeloma); both low suggests loss or malnutrition.
  • ALT, AST, bilirubin, alkaline phosphatase and INR — a low albumin with a raised bilirubin and prolonged INR indicates the liver has lost synthetic capacity (cirrhosis).
  • Urine albumin-to-creatinine ratio or 24-hour urine protein — confirms or excludes kidney protein loss; more than 3.5 g/day defines nephrotic-range proteinuria.
  • Creatinine and eGFR — kidney disease both leaks albumin and, when advanced, dilutes it through fluid retention.
  • Calcium (and corrected calcium) — total calcium reads low when albumin is low; corrected calcium = measured + 0.8 × (4.0 − albumin) tells you whether calcium is truly low.
  • Prealbumin (transthyretin) — half-life of two days, so it responds to nutritional changes within a week; low with a normal CRP supports a nutritional cause.
  • Fecal alpha-1 antitrypsin or celiac serology — when gut protein loss is suspected.

What usually happens next

  1. A mildly low albumin (3.0–3.4 g/dL) in someone who feels well is usually repeated in 4 to 8 weeks alongside CRP, liver tests, creatinine and a urine protein check; many are explained by a recent illness and recover.
  2. If CRP is high, the priority is finding and treating the source of inflammation; albumin is expected to recover over 3 to 6 weeks once it settles and is not a target in itself.
  3. If liver tests are abnormal, expect an INR, bilirubin, platelet count and usually an ultrasound or elastography (FibroScan) to stage liver disease.
  4. If urine protein is raised, a urine albumin-to-creatinine ratio, kidney function, lipids and often a kidney specialist referral and biopsy follow to identify the type of nephrotic syndrome.
  5. If inflammation, liver and kidney are all normal, a dietitian assessment of protein and energy intake, weight history and prealbumin, and sometimes celiac testing or a fecal alpha-1 antitrypsin for gut loss, are the next steps.
  6. Before planned surgery, an albumin under 3.0 g/dL is a reason to ask about delaying for nutritional optimisation where the operation allows, since it predicts complications.

Diet, lifestyle and natural levers with evidence

What can move Albumin (serum) once the cause is known. Nothing here replaces finding the cause.

Adequate protein and energy intake (1.0–1.5 g protein per kg per day when ill or older)

Moderate evidence

Albumin synthesis needs amino acids and energy, and when intake is the limiting factor it responds. Expert consensus (PROT-AGE, ESPEN) recommends 1.0–1.2 g of protein per kg daily for healthy older adults and 1.2–1.5 g/kg during illness or recovery, spread across meals. In trials of malnourished older adults and people recovering from hip fracture, meeting these targets raised albumin by about 0.2–0.3 g/dL over 8 to 12 weeks, with the largest gains in those whose CRP was normal. When inflammation is active, extra protein does little until the inflammation resolves.

People with advanced kidney disease who are not on dialysis usually need a lower, supervised protein target; those with cirrhosis should not restrict protein, but late-evening snacks and spreading intake help.

Oral nutritional supplements in malnutrition and dialysis

Moderate evidence

In people on hemodialysis, where albumin below 3.8–4.0 g/dL predicts poorer survival, a Cochrane review of 22 trials found oral protein-based supplements raised serum albumin by about 0.2 g/dL compared with usual care over 3 to 12 months, with the biggest effect in those starting below 3.5 g/dL. In hospital patients with malnutrition, supplements providing 400–600 kcal and 20–30 g of protein a day improved albumin modestly and reduced complications in several trials.

Branched-chain amino acids in cirrhosis

Moderate evidence

The liver in cirrhosis is short of branched-chain amino acids (leucine, isoleucine, valine), which are needed for albumin synthesis. In randomised trials in Italy and Japan, 12–14 g a day of BCAA granules for one to two years maintained or raised albumin by about 0.1–0.3 g/dL while it fell in control groups, and reduced the rate of complications such as ascites and hospital admission. A late-evening carbohydrate and protein snack reduces overnight muscle breakdown in cirrhosis with a similar effect.

BCAA supplements are a medical treatment in liver disease and should be taken under a hepatologist's guidance; they have no role in raising albumin in people without liver disease.

Stop drinking alcohol if liver disease is the cause

Strong evidence

In alcohol-related cirrhosis, abstinence is the single intervention most consistently shown to improve liver synthetic function. In cohort studies, albumin and INR improve over 3 to 6 months in people who stop drinking, and five-year survival in Child-Pugh class B cirrhosis is roughly 60–70 percent with abstinence compared with about 30–40 percent in those who continue. Albumin recovery is slow because of its three-week half-life and the time needed for liver regeneration.

Resistance exercise alongside adequate protein

Preliminary evidence

Muscle is the body's amino acid reserve, and resistance training combined with protein intake improves nitrogen balance. Small trials in older adults, people with chronic kidney disease and people on dialysis have reported albumin rises of around 0.1–0.2 g/dL over 3 to 6 months with twice-weekly resistance exercise plus protein, though not all studies show a change. The benefit for muscle mass and function is better established than the albumin effect.

Treat the inflammatory driver (gum disease, chronic infection, inflammatory disease flares)

Moderate evidence

Because inflammation suppresses albumin production and shifts it out of the bloodstream, controlling the source raises albumin more than any dietary change. In rheumatoid arthritis and inflammatory bowel disease, achieving remission is accompanied by albumin recovering by 0.3–0.8 g/dL over weeks; in dialysis patients, treating periodontal disease and infected access sites has been associated with CRP falling and albumin rising in cohort studies. Diet patterns that lower CRP (Mediterranean-style, high fibre) are associated with slightly higher albumin in population studies.

When to see a clinician promptly

  • Albumin below 2.5 g/dL, or any low albumin with rapidly increasing leg swelling, a swollen abdomen or shortness of breath: fluid is accumulating and the cause needs prompt identification.
  • Low albumin with yellowing of the skin or eyes, confusion, vomiting blood or black stools: possible decompensated liver disease, needs urgent care.
  • Low albumin with frothy urine, swelling around the eyes and raised blood pressure: possible nephrotic syndrome, which needs kidney assessment within days.
  • Low albumin with fever, a high CRP and feeling very unwell: significant infection or inflammation.
  • Low albumin with unexplained weight loss, persistent diarrhoea, blood in the stool or a change in bowel habit, which may indicate gut protein loss, inflammatory bowel disease, celiac disease or cancer.
  • An albumin under 3.0 g/dL before planned surgery, to discuss nutritional preparation and timing.

Frequently asked questions

What is a normal albumin level?

For adults, about 3.5 to 5.0 g/dL (35 to 50 g/L) on most US labs; some quote 3.4 to 5.4. Children run slightly higher, people over 70 slightly lower (3.2 to 4.8 is common), and albumin falls by up to 1 g/dL during pregnancy. A result just under your lab's lower limit, such as 3.3 or 3.4, is mildly low and is usually repeated rather than acted on.

Is an albumin of 3.2, 3.0 or 2.8 low?

Yes, all are below the usual 3.5 g/dL cut-off. An albumin of 3.2 is mildly low and often reflects a recent illness, chronic inflammation, older age or early liver or kidney disease. At 3.0 the reduction is moderate and worth investigating with CRP, liver tests and a urine protein check. At 2.8 the cause is usually significant, such as cirrhosis, nephrotic syndrome, gut protein loss or serious illness, and swelling may begin to appear.

What causes low albumin?

Four mechanisms: inflammation or infection (the most common, including after surgery and in cancer or autoimmune disease), reduced production by a damaged liver (cirrhosis), loss of albumin through the kidneys (nephrotic syndrome), gut (celiac disease, inflammatory bowel disease) or skin (burns), and inadequate protein and energy intake. Heart failure, overhydration and pregnancy lower it by dilution. A CRP, liver tests, creatinine and a urine protein test usually identify which is responsible.

What are the symptoms of low albumin?

Mildly low albumin (3.0 to 3.4 g/dL) causes no symptoms. As it falls below about 2.5 g/dL, fluid leaks out of the blood vessels and causes pitting swelling of the ankles and legs, puffiness around the eyes, a swollen abdomen (ascites) and sometimes breathlessness from fluid around the lungs. Fatigue, muscle loss, frothy urine (if the kidneys are the cause) and poor wound healing are also common. Many of the symptoms people notice come from the underlying disease rather than from the albumin itself.

How can I raise my albumin level?

By treating the cause. If inflammation or infection is driving it down, albumin recovers on its own over 3 to 6 weeks once the illness settles, and extra protein makes little difference until then. If intake is the problem, aiming for 1.2 to 1.5 g of protein per kg a day with enough calories, with oral nutritional supplements if needed, raises albumin by about 0.2 to 0.3 g/dL over two to three months. In liver disease, stopping alcohol and, under specialist guidance, branched-chain amino acids help; in kidney protein loss, treating the kidney condition is what works. Eating egg whites or taking albumin-rich foods does not directly top up blood albumin.

Does low albumin mean liver disease?

Not necessarily. The liver makes albumin, so advanced liver disease does lower it, but most low albumin results are caused by inflammation, infection, kidney or gut protein loss, or poor intake rather than by the liver. If your ALT, AST, bilirubin, alkaline phosphatase and clotting (INR) are normal and you have no other signs of liver disease, a low albumin is unlikely to be a liver problem. When the liver is the cause, albumin is usually accompanied by a raised bilirubin, a prolonged INR and a low platelet count.

How does low albumin affect calcium and medications?

About 40 percent of blood calcium is bound to albumin, so a low albumin makes the total calcium look low even when the active (ionized) calcium is normal. Labs or clinicians correct for this: corrected calcium = measured calcium + 0.8 × (4.0 − albumin in g/dL), so a calcium of 8.0 with an albumin of 2.5 corrects to 9.2, which is normal. Albumin also binds drugs such as phenytoin, warfarin and some antibiotics; when albumin is low, more of the drug is free and active, and doses or monitoring may need adjusting.

Does low albumin mean I am malnourished?

Not on its own. Albumin was once used as a nutrition marker, but it is now recognised that inflammation lowers it far more quickly and more often than poor intake does, and that well-nourished people with infections or after surgery routinely have low albumin. Current nutrition guidelines do not use albumin alone to diagnose malnutrition; weight loss, reduced intake, muscle loss and functional decline are the criteria. Albumin with a normal CRP, weight loss and a low prealbumin does support a nutritional cause.

References

  1. Albumin blood test. MedlinePlus, US National Library of Medicine (2024)View source
  2. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. Journal of Parenteral and Enteral Nutrition (2019)
  3. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Internal and Emergency Medicine (2012)
  4. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Seminars in Dialysis (2004)
  5. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Archives of Surgery (1999)
  6. Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. International Journal of General Medicine (2016)
  7. Marchesini G, Bianchi G, Merli M, et al.. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology (2003)
  8. Mah JY, Choy SW, Roberts MA, et al.. Oral protein-based supplements versus placebo or no treatment for people with chronic kidney disease requiring dialysis. Cochrane Database of Systematic Reviews (2020)
  9. Bauer J, Biolo G, Cederholm T, et al.. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association (2013)
  10. Kodner C. Diagnosis and management of nephrotic syndrome in adults. American Family Physician (2016)
  11. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. British Medical Journal (1973)
  12. Protein-energy undernutrition (PEU). Merck Manual Professional Version (2023)

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