THERAPY OF THE NEPHROTIC SYNDROME&lt;subtitle&gt;Sodium Restriction, Dextran, and Corticotropin (ACTH) Alone or Combined with Nitrogen Mustard&lt;/subtitle&gt;

Greenman, L.; Weigand, F. A.; Danowski, T. S.

doi:10.1001/archpedi.1955.02050110211005

Cited by 12 publications

(1 citation statement)

References 14 publications

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“…Data on 30 of these children have been reported earlier. 8 Seventytwo were initial attacks ; the remainder represented exacerbations. From the information in Tables 1A and IB it can be calculated that the mean age at which the initial episode of nephrotic syn¬ drome occurred in the group of 72 children was 4 years 4 months, with \y2 to 2y2 years the com¬ monest age of onset and a range of 4 months to 13 years 7 months in the remainder.…”

Section: Methodsmentioning

confidence: 99%

I. Clinical Results and Effects on Proteinuria in One Hundred Six Instances

Mateer¹,

Weigand²,

Greenman³

et al. 1957

Arch Pediatr Adolesc Med

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Intially corticotropin (ACTH) and cortisone were used only to induce diuresis in children with the nephrotic syndrome, though occasional remissions were produced.1-7 Most of these early trials were of short duration and the amounts of drugs administered were small because of limited supplies and the occurrence of side-effects such as edema, hypertension, and hypokalemia. The demonstration that such changes could be prevented or minimized by means of diets rigidly restricted in sodium and high in potassium 8 enabled us and others 9,10 to undertake more prolonged administration of large amounts of corticotropin and adrenocortical steroids in the hope of influencing the course of the underlying disease. Materials and MethodsDuring the past five years we have treated a total of 106 instances of nephrotic syndrome in children. All had persistent and usually massive proteinuria on admission. Each patient was treated in essentially the same way, and no attempt was made to exclude those with hypertension, formed elements in the urine, or azotemia. Data on 30 of these children have been reported earlier.8 Seventytwo were initial attacks ; the remainder represented exacerbations. From the information in Tables 1A and IB it can be calculated that the mean age at which the initial episode of nephrotic syn¬ drome occurred in the group of 72 children was 4 years 4 months, with \y2 to 2y2 years the com¬ monest age of onset and a range of 4 months to 13 years 7 months in the remainder. There were more boys than girls, 45 versus 27, and the latter were somewhat older at the first manifestation (4 years 9 months versus 4 years 2 months). Symptoms or signs of nephrotic syndrome, or both, had been present for one week to four years prior to hospitalization for the first course of corticotropin, with a mean duration of 27 weeks. This interval was much shorter, averaging four weeks, in patients who developed an exacerbation while under observation in the dispensary. A his¬ tory of an infection prior to or coincident with the first episode of nephrotic syndrome was obtained in 40 of the 72 patients, with upper respiratory in¬ fection in 34, unexplained fever in 3, varicella in 2, and rubeola in 1 (Table 1A). In the 18 patients admitted one to six times with a total of 34 exac¬ erbations, recrudescence followed an upper re¬ spiratory infection in 12 instances, bronchitis in 1 and was unassociated with any recognized infec¬ tion in the remaining 21 (Table IB). Beta-hemo¬ lytic streptococci were isolated from nose and throat cultures in only a minority of the initial and the subsequent attacks, 12% and 6%, respec¬ tively.

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Section: Methodsmentioning

confidence: 99%

I. Clinical Results and Effects on Proteinuria in One Hundred Six Instances

Mateer¹,

Weigand²,

Greenman³

et al. 1957

Arch Pediatr Adolesc Med

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The Treatment of the Nephrotic Syndrome with Steroids in Children and Adults

Lange¹

1957

Arch Intern Med

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Use of Combined Hormone and Mechlorethamine (Nitrogen Mustard) Therapy in Lipoid Nephrosis

West¹

1958

Arch Pediatr Adolesc Med

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The effectiveness of adrenal steroids and corticotropin (ACTH) in reversing the signs and chemical abnormalities associated with lipoid nephrosis is well known. In the majority of cases in which these agents are used, diuresis, cessation of albuminuria, and return to normality of the various serum constituents are observed. On the other hand, the effect of hormone therapy is short-lived, and many cases so treated will have one or more recurrences of the disease. It is doubtful whether use of hormone only at times when marked edema is present significantly alters the natural history of the disease1; the fatality rate for patients treated in this manner is approximately 25% to 35%.2,3In recent years an effort has been made to prevent recurrences by giving prolonged therapy with adrenal steroid or corticotropin while the disease is in remission. The patient is given small doses of hormone, usually steroid, daily, or, more frequently, large daily doses are given for three consecutive days each week in the so-called intermittent regimen.45 There is evidence that treatment designed in this manner to suppress recur¬ rences of the disease reduces the fatality rate.2 Despite this advance, difficulties arise.Children with active disease are rather fre¬ quently encountered who are refractory to hormone therapy in that, despite adminis¬ tration of the agent in high doses over a

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THERAPY OF THE NEPHROTIC SYNDROME<subtitle>Sodium Restriction, Dextran, and Corticotropin (ACTH) Alone or Combined with Nitrogen Mustard</subtitle>

Cited by 12 publications

References 14 publications

I. Clinical Results and Effects on Proteinuria in One Hundred Six Instances

I. Clinical Results and Effects on Proteinuria in One Hundred Six Instances

The Treatment of the Nephrotic Syndrome with Steroids in Children and Adults

Use of Combined Hormone and Mechlorethamine (Nitrogen Mustard) Therapy in Lipoid Nephrosis

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