NEPHROTIC SYNDROME

Abstract

The effects of short term ACTH treatment (4 to 6 days) in 14 patients with the nephrotic syndrome are presented. Five patients given eight courses showed complete clearing of edema in seven instances, one failing to show any response to a second course. Four patients given six courses showed significant but incomplete clearing of edema each time. Five patients showed no clinically significant response to seven courses.[See Table 5 in Source Pdf] The type of diuresis with regard to salt and water excretion was similar to that seen with spontaneous diuresis. In all but one instance the patients who failed to have a clinically significant response did, nevertheless, show a slight sodium diuresis after with drawal of the drug. There were no consistent changes in the significant chemical findings in the blood, except that in most cases, regardless of clinical results, a drop in the level of total cholesterol was observed after treatment. Several patients who received sodium lactate by mouth following diuresis did not accumulate edema and had a pronounced increase in the urinary sodium. This suggests that at least temporarily their kidneys were capable of dealing with sodium in normal fashion. The period of post-treatment studies on these patients varies from 7 to 15 months. Some of the patients have remained symptom-free, others have relapsed several times but responded to subsequent periods of treatment, still others after early successes have failed to respond to later ACTH administration. Only one of the group has shown clearing of the urine suggesting a permanent remission. Thus the use of this hormone at best offers only a means of controlling edema of the nephrotic syndrome. Whether its repeated use may alter the over-all prognosis can only be determined after a much longer period of observation. It should, however, prove useful in the study of the mechanism of diuresis.