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

Abstract

29 children with the nephrotic syndrome were studied by clinical, biochemical, and renal function technics. Detailed data pertaining to these moieties are presented. Conventional clinical criteria frequently proved unreliable early in the course of the nephrotic syndrome either as indices of the functional status of the kidneys or as guides to the subsequent course. The coexistence of anemia, acidosis and azotemia usually was correlated with persistent reduction in renal function and indicated probable morphologic nephron damage with poor prognosis. In general, however, the biochem. and renal functional patterns indicated an initial, often reversible physiol. change in nephron function. With progressive disease, the data suggested that inreversible parenchymal destruction gradually superseded the earlier physiologic changes and culminated in renal failure. In this view, "pure or lipoid nephrosis," "mixed nephritis" or "nephrotic stage of subacute or chronic glomerulonephritis" are synonyms for a form of renal disease in which functional alterations and eventual anatomic change indicate that the glomerulus is a primary site of the disease process. That the degree of irreversible impairment tends to be somewhat different in children than in adults is evident from the relatively good prognosis of children with this disease.