By a study of plasma esterase in various hypoproteinemic states information was gained concerning the synthesis of a protein by the liver, which may be applicable to the problem of albumin synthesis. Patients with infectious hepatitis and cirrhosis showed defective formation of plasma esterase that paralleled the defect in albumin formation. The defect could only be altered in patients with cirrhosis by very prolonged therapy indicating that liver function itself had to improve before the proteins could be formed in a normal manner. Patients with the nephrotic syndrome showed a normal or hypernormal formation of plasma esterase. Following spontaneous remissions or the administration of albumin the esterase level showed a marked rise which was in direct contrast to the difficult alterability of the enzyme level in patients with severe liver involvement. It is suggested that the defect in protein synthesis by patients with the nephrotic syndrome may be due to the lack of certain essential materials, one of which may be albumin itself, rather than to any abnormality in the liver.

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