The failure of children with the nephrotic type of Bright's disease to regenerate plasma protein when fed a diet approximately optimal for the assimilation of nitrogen cannot be attributed solely to loss of protein in the urine in all cases; sometimes severe hypoalbuminemia occurs with but slight loss of urinary protein.1 Further, rapid regeneration of plasma protein during recovery is, within wide limits, independent of the protein content of the diet.
In observing nephrotic children in this clinic we have also noted that acute febrile episodes with peritoneal symptoms were most frequent in patients with a plasma albumin content below 1 Gm. per hundred cubic centimeters. Sometimes these episodes were accompanied by pneumococcic bacteremia and peritonitis, but often an episode ran its course without such infection. It was suggested in a previous study that when bacterial invasion occurs it may be secondary to acute disturbances in metabolism which cause