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

Abstract

The "nephrotic syndrome" may be defined as a combination of clinical and laboratory findings including massive edema, marked proteinuria, hypoproteinemia, and hyperlipemia. This syndrome may be associated with such diseases as diabetes mellitus (Kimmelstiel-Wilson syndrome), renal amyloidosis, renal vein thrombosis, syphilis, and heavy-metal poisoning. However, in common usage nephrosis or the nephrotic syndrome refers to the so called "pure" or "lipid" nephrosis and to the nephrotic stage of glomerulonephritis. It is possible that the latter two forms are caused by the same basic mechanisms. Pathogenesis and Pathologic Physiology We believe that nephrosis is a distinct disease with an immunologic basis and is characterized by a complement-binding antigen-antibody reaction. This antigen-antibody reaction acts to produce functional and, when persistent, morphologic tissue damage. It is probable that not only the glomerular capillary but many of the other capillaries in the body are similarly altered, leading to a generalized increase in glomerular and