Treatment of the Uncomplicated Nephrotic Syndrome in Children with Triamcinolone: a Six-Year Study

Abstract

TIE tiel)lirotic syndrome is a disease, the cause of which is unknown, the treatment unsatisfactory, and the prognosis uncertain. The uncomplicated nephrotic syndrome in children is characterized by the presence of edema, hypoproteinemia, hyperlipemia, and proteinuria, and by the absence of persistent hypertension, azotemia and gross hematuria. The more complicated forms include neonatal or infantile nephrosis, nephrosis superimposed upon severe diabetes, and the nephropathies of syphilis, amyioidosis, disseminated lupus erythematosus., and acute and chronic glomerulonephritis.The introduction of antibiotics has eliminated almost completely the secondary serious infections such as primary streptococcal or pneumococcal peritonitis and the migrating erysipelas which took such a large toll in pre-antibiotic days. In nearly all cases the giving of steroids reverses the clinical and the chemical findings that characterize the disease, and has made it possible for most patients to live a normal life in spite of occasional mild proteinuria. Thus, morbidity has decreased while the matter of survival remains an open question.The side reactions from cortisone and ACTH, some quite distressing, have stimulated a search for more effective synthetic steroids-among them hydrocortisone, fluorohydrocortisone, Ai fluorohydrocortisone and Ai-9 alpha fluara-I6 alpha hydroxy-hydrocortisone (triamcinolone). Studies by Hellman et aU with triamcinolone in chronic arthritis were suggestive of a favorable therapeutic effect without the unfavorable reactions of other steroids. The absence of fluid and sodium retention and potassium depletion was stressed specifically. This finding suggested to Hellman eat al. the use of triamcinolone in 15 children suffering from the nephrotic syn-* Attending Pediatrician, Maimonides Hospital;