In a patient with nephrotic syndrome and edema, what does a continued fall in serum albumin levels indicate?

In nephrotic syndrome, the underlying issue is related to increased permeability of the glomeruli, which leads to significant protein loss in urine. When serum albumin levels continue to fall, it is primarily indicative of ongoing proteinuria — the loss of protein through the urine. This loss means that the body is not retaining its proteins as it normally would, leading to lower levels in the bloodstream.

As a result, when albumin levels decrease, it suggests that the condition is worsening and that the kidneys are still actively allowing proteins to pass into the urine, exacerbating edema and potential complications. This scenario accurately reflects the pathology of nephrotic syndrome, confirming that the body is unable to maintain adequate serum protein levels due to the renal loss of proteins.