Corticosteroids and antidiuretic substance in nephrotic children.

I NCREASE in urinary volume and disappearance of edema following administration of adrenocorticotrophic hormone (ACTH) and cortisone to patients suffering from the nephrotic syndrome have been reported by several investigators.1-6 This therapeutic approach to edema does not rule out the primary renal nature of the nephrotic syndrome. In spite of the remarkable diuretic effect of such compounds it was found that the disease follows its usual course in most cases and temporary improvement of renal function does not go beyond the limit allowed by the remaining normal nephrons. Changes in tubular reabsorptive capacity were found in some of the authors’ cases7’ 8 during studies on clearance tests and albumin therapy. The authors suggested that nephrotic edema was partly dependent upon increased tubular reabsorption. This was also the opinion of Eder and collaborators9 and it was so commented upon by H. W. Smith,1#{176} in a critical analysis. An increase in urine output, on the other hand, may occur not only after an increase in the glomerular filtration rate (GRF) above previous value3’ 11-13 but also from a decreased tubular reabsorption8’ 14 and with or without changes in the filtration fraction.15 The endocrine role in nephrotic edema and in spontaneous and induced diuresis has been studied by only a few individuals. Robinson and Farr16 reported the