PEDIATRICS Vol. 19 No. 4 April 1957, pp. 639-650
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCrory, W. W.
Right arrow Articles by Macaulay, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McCrory, W. W.
Right arrow Articles by Macaulay, D.

RECENT ADVANCES IN THE MANAGEMENT OF RENAL DISEASE IN CHILDREN (Part II)

Wallace W. McCrory M.D.1 and Duncan Macaulay M.D., M.R.C.P.2

1 The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine
2 The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Department of Child Health, Manchester University, Manchester, England.

The last decade has provided the interested physician with a number of advances in the management of these complicated problems. A means of prompt diagnosis of the existence of chronic renal insufficiency is often afforded the physician by the presence of certain common but typical symptoms (failure of growth, recurrent bouts of vomiting, and/or dehydration without apparent cause, convulsions, refractory anemia, and bone disease). Early recognition of the existence of chronic renal failure is very important since the rate of deterioration of renal function can be lessened by eradicating associated active infection of the urinary tract and prompt surgical intervention when indicated for relief of obstructive uropathy. Since progressive loss of functioning renal tissue may result from a number of different disturbances (congenital hypoplasia or obstructive unopathy with or without associated infection, other anomalies, polycystic kidneys, chronic pyelonephritis, or glomerulonephritis, etc.) exact diagnosis is essential for the establishment of appropriate therapy. Symptomatic improvement manifested by return of appetite, relief of vomiting, increased activity tolerance, and at times some degree of growth can be achieved by foregoing a "do nothing" attitude. Only the principles of treatment will be reviewed and available sources should be consulted for details. An increased intake of water and output of urine is needed to permit excretion of solutes by a kidney with limited concentrating and diluting abilities. Since patients with renal insufficiency have a limited capacity for flexibility in renal response to administered loads of water, electrolyte, and solutes, excesses or inadequacies in intake are not tolerated and should be avoided. Regulation of the content of electrolytes in the body is aimed at maintaining the patient at his symptomatic best rather than chemically normal.