Assimilation of Protein by Young Children With the Nephrotic Syndrome

Abstract

Previous observations of the effect of dietary protein,1 fat and carbohydrate 2 on the nitrogen balance of young children with the nephrotic syndrome revealed the fact that protein intakes above the optimum of 3 Gm. daily per kilogram of body weight tended to produce a less positive or even a negative nitrogen balance in these children. There still remained unexplained fluctuations in the nitrogen balance unrelated to diet and in the absence of infection.It is well known that nephrotic children are susceptible to acute infections, particularly pneumococcic peritonitis. MacLeod and Farr 3 found that these attacks are usually due to infection not by freshly acquired organisms but by organisms which have been carried for some time. The infections appear to result primarily from some metabolic disturbance, as a result of which resistance is lowered and a previously harmless organism invades the blood and the peritoneal fluid.Since publication of the report just cited3 we have found that the acute metabolic disturbance can occur without being followed by the infection. There are fever, abdominal pain, prostration and acute malaise, without demonstrable organisms in the blood or in the peritoneal fluid. Without infection, the attack passes in twelve to forty-eight hours. The present paper deals with the nitrogen balance during these noninfectious attacks, which will be termed "nephrotic crises."For comparison, I also include studies made before, during and after acute infections of the respiratory tract without nephrotic crises.