Renal tubular insufficiency exclusive of tubular insufficiency attributed to chronic pyelonephritis and hydronephrosis is infrequently encountered in pediatric practice. Nevertheless, an increasing number of clinical syndromes have been ascribed to such insufficiency, and the pediatrician must be aware of their existence. A continuous search for these diseases may enable him to make an accurate diagnosis and to institute palliative or even curative therapy. The syndrome of acute renal tubular failure is usually recognized by sudden onset of oliguria or anuria in association with crush injuries, transfusion reactions, ingestion of poisons, or sulfonamide administration, and is not considered in this presentation. In contrast, the syndromes of chronic renal tubular insufficiency are more insidious in their onset and should be suspected in infants and children who fail to thrive and who have polyuria, polydipsia, thermolability, or rickets.
With few exceptions, the chronic affections of the renal tubules have been described during the