The Nephrotic Syndrome in Children. An Interpretation of Its Clinical, Biochemical, and Renal Hemodynamic Features as Variations of a Single Type of Nephron Disease 12

A Study of the Mechanisms of Edema Formation in Patients with the Nephrotic Syndrome 1

“…On the 16th day (Nov. [16][17]1948) 5 mg. of desoxycorticosterone acetate were injected intramuscularly (see Figures 14 and 15 in the Appendix for other effects of the hormone). On the 18th day after the last albumin infusion (Dec. [21][22] excretion of chloride was measured instead of sodium. By this time considerable edema had reaccumulated and the measurements were again similar to those of the control day (Oct. [27][28]1948 …”

“…Gonversely, it is possible that edema accumulation in these patients was associated with a decrease in GFR. However, edema occurs also in some patients in whom GFR and other discrete renal functions are normal or even supernormal (19)(20)(21)(22). It is evident, therefore, that even though GFR is within or above the statistical range of normal it (11) and others.…”

On the Role of the Kidney during Nephrotic Edema: Potassium Excretion and Sodium Retention 1

“…15The improved filtration rate and filtration fraction with ACTH therapy (21,36) may result from improvement in the thickened glomerular basement membrane, which appears to be a primary lesion in the nephrotic syndrome (22,37,38). With an improvement in this lesion, diminished glomerular permeability to albumin has been reported (10).…”

John Howland Award Acceptance Address: From the American Pediatric Society, April 26,1978, New York, New York

“…Gretchen Hutchins Moll, and Niilo Hallman, a Finnish postwar fellow, now a world pediatric leader, carefully studied ou; early attempts to produce remissions either with albumin infusions or by inducing an attack of measles (1 1). A little later, Jack Metcoff joined the group to correlate the course of the disease with serial changes in physiologic measurements of renal function (12). Then came David Gitlin, after completing his house officer training.…”