Treatment of the Nephrotic Syndrome in Childhood

Abstract

THE INTRODUCTION into clinical use of adrenocorticotropic hormone (ACTH) and later of cortisone and its analogues caused a marked change in prognosis for children affected with the nephrotic syndrome. Initial enthusiasm was somewhat dampened by subsequent observations that the diuresis achieved was often temporary and proteinuria frequently persisted. These deficiencies were largely controlled by prolonging therapy beyond initial diuresis. Recent reports^1-4 of studies from a number of centers treating with various ACTH and long-term steroid regimens uniformly substantiate their therapeutic efficacy in producing and maintaining remissions, thus reducing morbidity and mortality. The untoward effects of high-dosage, long-term steroid therapy are generally recognized.⁵ The Cushingoid appearance of such children commonly results in adverse behavioral manifestations such as depression, withdrawal, and aggressiveness, which in turn lead to decreased school attendance and poor intellectual performance. Moreover, a number of serious and at times life-threatening pathophysiologic effects frequently are produced, such as