LIPOID NEPHROSIS

Abstract

Clinical and biochemical studies of 40 children with lipoid nephrosis are evaluated. Twenty-six (65 %) are alive; 19 have been entirely well for 1 to 16 years, including three who had minimal hematuria on various occasions. Three have been well for less than a year, one still has proteinuria only, and three still have active disease. Of 22 children who had received sulfonamides for infections, only three have died. Necropsy was done on 10 of the 14 children who died. Minor glomerular changes were seen in the kidneys of four children not known to have had hematuria. Pronounced glomerular changes occurred in two children who had minimal hematuria. Of the four children who did not show any glomerular changes, two had minimal hematuria on several occasions. Pathologic changes in the liver were minimal unless acacia had been given.

Laboratory determinations revealed no significant alteration of the prothrombin time. Most of the increase in the plasma fats was in the cholesterol fraction. The precentage of cholesterol esters was not decreased. In case of recovery, the cholesterol seemed to return to normal values at a slower rate than the serum albumin. Plasma fat reached values exceeding 5 gm./100 ml. in some instances. No "critical edema level" for albumin was found. The erythrocyte sedimentation test was a reliable guide in determining the course of the disease.

Choline citrate (0.8 gm. each day), given to seven children for prolonged periods, failed to produce essential changes in the plasma fats or definite clinical improvement.

Periods of sudden change in edema were found to be critical times for the nephrotic child. Two children developed cardiac failure after injection of large volumes of sucrose.

Early diagnosis is important, for treatment is most effective in the early stage.

The prognosis is good since the advent of chemo- and antibiotic therapy, and is not impaired by prolonged duration of the disease. Growth of the children who recover is good.