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June 1957, Vol 93, No. 6 >
Article | June 1957

II. Laboratory Findings in One Hundred Six Instances FREE

T. S. DANOWSKI, M.D.; F. A. WEIGAND, M.D.; LAWRENCE GREENMAN, M.D.; S. GAILANI, M.D.; W. V. GREENBERG, M.D.; F. M. MATEER, M.D.
[+] Author Affiliations

Submitted for publication Jan. 18, 1957; accepted Feb. 18.

Aided by grants from the Western Pennsylvania Heart Association, the American Medical Association and the American Cancer Society (Allegheny County Chapter and the M. O. Freas Estate).

Dr. Greenman died June 20, 1956.

Dr. Gustav Martin and the National Drug Company provided the supplies of corticotropin.


AMA Am J Dis Child. 1957;93(6):604-614. doi:10.1001/archpedi.1957.02060040606002.
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References
Comments

In a previous report we have described the clinical results and the changes in proteinuria in a total of 106 instances of nephrotic syndrome in children treated, usually for 28 days, with corticotropin (ACTH),* 100 to 200 units per day, a very low-sodium high-potassium diet, and penicillin.1 The alterations in the formed elements of the blood, in serum and blood solutes, and in urinary reducing substances and 17-ketosteroids prior to, during, and following therapy are herein presented.

Materials and Methods  Erythrocyte, leukocyte, and differential blood cell counts; the hemoglobin content; the levels of whole-blood nonprotein nitrogen and sugar; the presence of reducing substances in the urine (Benedict's test); the concentrations of carbon dioxide, chloride, sodium, potassium, total protein, albumin, globulin, calcium, inorganic phosphorus, and cholesterol in serum, and the 24-hour excretion rates of urinary 17-ketosteroids were measured at approximately weekly intervals before, during, and after therapy by methods in

REFERENCES

1 +
Mateer, F. M.; Weigand, F. A.; Greenman, L.; Weber, C. J., Jr.; Kunkel, G. A., and Danowski, T. S.:  Corticotropin (ACTH) Therapy of Nephrotic Syndrome in Children: I. Clinical Results and Effects on Proteinuria in 106 Instances , A. M. A. J. Dis. Child , this issue, p. 591.
2 +
Danowski, T. S.; Greenman, L.; Mateer, F. M.; Parsons, W. B.; Weigand, F. A.; Mermelstein, H., and Peters, J. H.:  Carboxylic Cation Exchange Resin Effects in Dogs , J. Clin. Invest. 30:984, 1951;.
3 +
Holtorff, A. F., and Koch, F. C.:  The Colorimetric Estimation of 17-Ketosteroids and Their Application to Urine Extracts , J. Biol. Chem. 135: 377, 1940;.
4 +
Hills, A. G.; Forsham, P. H., and Finch, C. A.:  Changes in Circulating Leukocytes Induced by the Administration of Pituitary Adrenocorticotrophic Hormone (ACTH) in Man , Blood 3:755, 1948;.
5 +
Dougherty, T. F., and White, A.:  Influence of Hormones on Lymphoid Tissue Structure and Function: Role of Pituitary Adrenotrophic Hormone in Regulation of Lymphocytes and Other Cellular Elements of Blood , Endocrinology 35:1, 1944;.
6 +
Emerson, K. J., and Dole, V. P.:  Diodrast and Inulin Clearances in Nephrotic Children with Supernormal Urea Clearances , J. Clin. Invest. 22:447, 1943;.
7 +
Metcoff, J.; Kelsey, W. M., and Janeway, C. A.:  The Nephrotic Syndrome in Children: An Interpretation of Its Clinical, Biochemical, and Renal Hemodynamic Features as Variations of a Single Type of Nephron Disease , J. Clin. Invest. 30:471, 1951;.
8 +
Barnett, H. L.; Forman, C. W.; McNamara, H.; McCrory, W. W.; Rapoport, M.; Michie, A. J., and Barbero, G.:  The Effect of Adrenocorticotrophic Hormone on Children with the Nephrotic Syndrome: II. Physiologic Observations on Discrete Kidney Functions and Plasma Volume , J. Clin. Invest. 30:227, 1951;.
9 +
Parson, W.; Crispell, K. R., and Ebbert, A., Jr.:  Abnormalities in N15 Excretion Rates After Ingestion of Tagged Glycine in Cushing's Syndrome and Following ACTH Administration , J. Clin. Invest. 31:548, 1952;.
10 +
Clark, I.:  The Effect of Cortisone upon Protein Synthesis , J. Biol. Chem. 200:69, 1953;.
11 +
Albanese, A. A.; Higgons, R. A.; Arnold, W. H., and Hays, D. R.:  Effect on ACTH, Cortisone and Salicylates on Protein Synthesis in Man , Fed. Proc. 13:173, 1954;.
12 +
Pearson, O. H., and Eliel, L. P.:  Experimental Studies with ACTH and Cortisone in Patients with Neoplastic Disease , Recent Prog. Hormone Res. 6:373, 1951;.
13 +
Long, C. N. H.:  The Endocrine Control of the Blood Sugar (Banting Lecture) , Diabetes 1:3, 1952;.
14 +
Hausberger, F. X., and Hausberger, B. C.:  Over-All Glucose Utilization in Steroid Diabetic Guinea Pigs , Am. J. Physiol. 183:302, 1955;.
15 +
Stadie, W. C.; Haugaard, N., and Marsh, J. B.:  The Effect of Growth Hormone and Cortisone on the Action of Bound Insulin , J. Biol. Chem. 198:785, 1952;.
16 +
Reckendorf, H. K.; McGavack, T. H., and Bolukoglu, M. A.:  Alterations in Renal Threshold for Sugar by Oral Administration of Cortisone Acetate , Proc. Soc. Exper. Biol. & Med. 90:75, 1955;.
17 +
Kelley, V. C.; Ziegler, M. R.; Doeden, D., and McQuarrie, I.:  Labeled Methionine as an Indicator of Protein Formation in Children with Lipoid Nephrosis , Proc. Soc. Exper. Biol. & Med. 75:153, 1950;.
18 +
Chaptal, J.; Jean, R.; Campo, C., and Dossa, D.:  The Biological Syndrome of Lipid Nephrosis and Its Physiopathology , Péediatrie 11:149, 1956;.
19 +
Lange, K.; Craig, F.; Oberman, J.; Slobody, L.; Ogur, G., and LoCasto, F.:  Changes in Serum Complement During the Course and Treatment of Glomerulonephritis , A. M. A. Arch. Int. Med. 88:433, 1951;.
20 +
Lange, K.; Slobody, L. B., and Strang, R. H.:  Serum Complement Levels as a Guide for Diagnosis and Therapy of the Nephrotic Syndrome , J. Clin. Invest. 32:581, 1953;.
21 +
Lange, K., and Wenk, E. J.:  Investigations into the Site of Complement Loss in Acute Human and Experimental Glomerulonephritis and the Nephrotic Syndrome , A. M. A. Am. J. Dis. Child. 88:639, 1954;.
22 +
Sadhu, D. P., and Mookerjea, S.:  Studies on the Mechanism of Cholesterol Synthesis in Nephrosis , Metabolism 4:531, 1955;.
23 +
Conn, J. W.; Vogel, W. C.; Louis, L. H., and Fajans, S. S.:  Serum Cholesterol: Probable Precursor of Adrenal Cortical Hormones , J. Lab. & Clin. Med. 35:504, 1950;.
24 +
Adlersberg, D.; Schaefer, L. E., and Dritch, R.:  Effect of Cortisone, Adrenocorticotropic Hormone (ACTH), and Desoxycorticosterone Acetate (DOCA) on Serum Lipids , abstracted, J. Clin. Invest. 29:795, 1950;.
25 +
Adlersberg, D.; Schaefer, L. E., and Drachman, S. R.:  Studies on Hormonal Control of Serum Lipid Partition in Man , J. Clin. Endocrinol. 11:67, 1951;.
26 +
Heppel, L. A.:  The Electrolytes of Muscle and Liver in Potassium-Depleted Rats , Am. J. Physiol. 127:385, 1939;.
27 +
Darrow, D. C.; Schwartz, R.; Iannucci, J. F., and Coville, F.:  The Relation of Serum Bicarbonate Concentration to Muscle Composition , J. Clin. Invest. 27:198, 1948;.
28 +
Moore, F. D.; Boling, E. A.; Ditmore, H. H., Jr.; Sicular, A.; Teterick, J. E.; Ellison, A. E.; Hoye, S. J., and Ball, M. R.:  Body Sodium and Potassium: V. The Relationship of Alkalosis, Potassium Deficiency and Surgical Stress to Acute Hypokalemia in Man , Metabolism 4:379, 1955;.
29 +
Danowski, T. S.:  Respiratory Acidosis and Hypochloremic Alkalosis: Origins, Differentiation, Effects and Therapy , Diabetes 5:323, 1956;.
30 +
Danowski, T. S.; Fergus, E. B., and Mateer, F. M.:  The Low Salt Syndromes , Ann. Int. Med. 43:643, 1955;.
31 +
Luetscher, J. A., Jr., and Johnson, B. B.:  Chromatographic Separation of the Sodium-Retaining Corticoid from the Urine of Children with Nephrosis, Compared with Observations on Normal Children , J. Clin. Invest. 33:276, 1954;.
32 +
Albrink, M. J.; Hald, P. M., and Man, E. B.:  Water Content of Hyperlipemic Serum , abstracted, J. Clin. Invest. 33:914, 1954;.
33 +
Sims, E. A. H.; Welt, L. G.; Orloff, J., and Needham, J. W.:  Asymptomatic Hyponatremia in Pulmonary Tuberculosis , J. Clin. Invest. 29: 1545, 1950;.
34 +
Danowski, T. S.: Diabetes Mellitus with Emphasis on Children and Young Adults ,  Ch. 21 , Baltimore, Williams & Wilkins, to be published.
35 +
Farnsworth, E. B.:  Correlation of Excreted Compounds E and F with Clinical Course of a Nephrosis Patient Treated with ACTH and Compounds E and F , abstracted, J. Pharmacol. & Exper. Therap. 110:17, 1954;.
36 +
Deane, H. W.; Shaw, J. H., and Greep, R. O.:  Effect of Altered Sodium or Potassium Intake on Width and Cytochemistry of Zona Glomerulosa of Rat's Adrenal Cortex , Endocrinology 43: 133, 1948;.
37 +
Badinez, O., and Croxatto, H.:  Modifications histológicas de la corteza suprarrenal en la rata provocadas por la administración de cloruro de potasio y cloruro de sodio , Bol. Soc. biol. Santiago 5:40, 1948;.
38 +
Jones, I. C., and Roby, C. C.:  Some Aspects of Zonation and Function of the Adrenal Cortex: I. The Effects of Hypophysectomy on the Adrenal Cortex of the Adult Male Mouse , J. Endocrinol. 10:245, 1954;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Mateer, F. M.; Weigand, F. A.; Greenman, L.; Weber, C. J., Jr.; Kunkel, G. A., and Danowski, T. S.:  Corticotropin (ACTH) Therapy of Nephrotic Syndrome in Children: I. Clinical Results and Effects on Proteinuria in 106 Instances , A. M. A. J. Dis. Child , this issue, p. 591.
2 +
Danowski, T. S.; Greenman, L.; Mateer, F. M.; Parsons, W. B.; Weigand, F. A.; Mermelstein, H., and Peters, J. H.:  Carboxylic Cation Exchange Resin Effects in Dogs , J. Clin. Invest. 30:984, 1951;.
3 +
Holtorff, A. F., and Koch, F. C.:  The Colorimetric Estimation of 17-Ketosteroids and Their Application to Urine Extracts , J. Biol. Chem. 135: 377, 1940;.
4 +
Hills, A. G.; Forsham, P. H., and Finch, C. A.:  Changes in Circulating Leukocytes Induced by the Administration of Pituitary Adrenocorticotrophic Hormone (ACTH) in Man , Blood 3:755, 1948;.
5 +
Dougherty, T. F., and White, A.:  Influence of Hormones on Lymphoid Tissue Structure and Function: Role of Pituitary Adrenotrophic Hormone in Regulation of Lymphocytes and Other Cellular Elements of Blood , Endocrinology 35:1, 1944;.
6 +
Emerson, K. J., and Dole, V. P.:  Diodrast and Inulin Clearances in Nephrotic Children with Supernormal Urea Clearances , J. Clin. Invest. 22:447, 1943;.
7 +
Metcoff, J.; Kelsey, W. M., and Janeway, C. A.:  The Nephrotic Syndrome in Children: An Interpretation of Its Clinical, Biochemical, and Renal Hemodynamic Features as Variations of a Single Type of Nephron Disease , J. Clin. Invest. 30:471, 1951;.
8 +
Barnett, H. L.; Forman, C. W.; McNamara, H.; McCrory, W. W.; Rapoport, M.; Michie, A. J., and Barbero, G.:  The Effect of Adrenocorticotrophic Hormone on Children with the Nephrotic Syndrome: II. Physiologic Observations on Discrete Kidney Functions and Plasma Volume , J. Clin. Invest. 30:227, 1951;.
9 +
Parson, W.; Crispell, K. R., and Ebbert, A., Jr.:  Abnormalities in N15 Excretion Rates After Ingestion of Tagged Glycine in Cushing's Syndrome and Following ACTH Administration , J. Clin. Invest. 31:548, 1952;.
10 +
Clark, I.:  The Effect of Cortisone upon Protein Synthesis , J. Biol. Chem. 200:69, 1953;.
11 +
Albanese, A. A.; Higgons, R. A.; Arnold, W. H., and Hays, D. R.:  Effect on ACTH, Cortisone and Salicylates on Protein Synthesis in Man , Fed. Proc. 13:173, 1954;.
12 +
Pearson, O. H., and Eliel, L. P.:  Experimental Studies with ACTH and Cortisone in Patients with Neoplastic Disease , Recent Prog. Hormone Res. 6:373, 1951;.
13 +
Long, C. N. H.:  The Endocrine Control of the Blood Sugar (Banting Lecture) , Diabetes 1:3, 1952;.
14 +
Hausberger, F. X., and Hausberger, B. C.:  Over-All Glucose Utilization in Steroid Diabetic Guinea Pigs , Am. J. Physiol. 183:302, 1955;.
15 +
Stadie, W. C.; Haugaard, N., and Marsh, J. B.:  The Effect of Growth Hormone and Cortisone on the Action of Bound Insulin , J. Biol. Chem. 198:785, 1952;.
16 +
Reckendorf, H. K.; McGavack, T. H., and Bolukoglu, M. A.:  Alterations in Renal Threshold for Sugar by Oral Administration of Cortisone Acetate , Proc. Soc. Exper. Biol. & Med. 90:75, 1955;.
17 +
Kelley, V. C.; Ziegler, M. R.; Doeden, D., and McQuarrie, I.:  Labeled Methionine as an Indicator of Protein Formation in Children with Lipoid Nephrosis , Proc. Soc. Exper. Biol. & Med. 75:153, 1950;.
18 +
Chaptal, J.; Jean, R.; Campo, C., and Dossa, D.:  The Biological Syndrome of Lipid Nephrosis and Its Physiopathology , Péediatrie 11:149, 1956;.
19 +
Lange, K.; Craig, F.; Oberman, J.; Slobody, L.; Ogur, G., and LoCasto, F.:  Changes in Serum Complement During the Course and Treatment of Glomerulonephritis , A. M. A. Arch. Int. Med. 88:433, 1951;.
20 +
Lange, K.; Slobody, L. B., and Strang, R. H.:  Serum Complement Levels as a Guide for Diagnosis and Therapy of the Nephrotic Syndrome , J. Clin. Invest. 32:581, 1953;.
21 +
Lange, K., and Wenk, E. J.:  Investigations into the Site of Complement Loss in Acute Human and Experimental Glomerulonephritis and the Nephrotic Syndrome , A. M. A. Am. J. Dis. Child. 88:639, 1954;.
22 +
Sadhu, D. P., and Mookerjea, S.:  Studies on the Mechanism of Cholesterol Synthesis in Nephrosis , Metabolism 4:531, 1955;.
23 +
Conn, J. W.; Vogel, W. C.; Louis, L. H., and Fajans, S. S.:  Serum Cholesterol: Probable Precursor of Adrenal Cortical Hormones , J. Lab. & Clin. Med. 35:504, 1950;.
24 +
Adlersberg, D.; Schaefer, L. E., and Dritch, R.:  Effect of Cortisone, Adrenocorticotropic Hormone (ACTH), and Desoxycorticosterone Acetate (DOCA) on Serum Lipids , abstracted, J. Clin. Invest. 29:795, 1950;.
25 +
Adlersberg, D.; Schaefer, L. E., and Drachman, S. R.:  Studies on Hormonal Control of Serum Lipid Partition in Man , J. Clin. Endocrinol. 11:67, 1951;.
26 +
Heppel, L. A.:  The Electrolytes of Muscle and Liver in Potassium-Depleted Rats , Am. J. Physiol. 127:385, 1939;.
27 +
Darrow, D. C.; Schwartz, R.; Iannucci, J. F., and Coville, F.:  The Relation of Serum Bicarbonate Concentration to Muscle Composition , J. Clin. Invest. 27:198, 1948;.
28 +
Moore, F. D.; Boling, E. A.; Ditmore, H. H., Jr.; Sicular, A.; Teterick, J. E.; Ellison, A. E.; Hoye, S. J., and Ball, M. R.:  Body Sodium and Potassium: V. The Relationship of Alkalosis, Potassium Deficiency and Surgical Stress to Acute Hypokalemia in Man , Metabolism 4:379, 1955;.
29 +
Danowski, T. S.:  Respiratory Acidosis and Hypochloremic Alkalosis: Origins, Differentiation, Effects and Therapy , Diabetes 5:323, 1956;.
30 +
Danowski, T. S.; Fergus, E. B., and Mateer, F. M.:  The Low Salt Syndromes , Ann. Int. Med. 43:643, 1955;.
31 +
Luetscher, J. A., Jr., and Johnson, B. B.:  Chromatographic Separation of the Sodium-Retaining Corticoid from the Urine of Children with Nephrosis, Compared with Observations on Normal Children , J. Clin. Invest. 33:276, 1954;.
32 +
Albrink, M. J.; Hald, P. M., and Man, E. B.:  Water Content of Hyperlipemic Serum , abstracted, J. Clin. Invest. 33:914, 1954;.
33 +
Sims, E. A. H.; Welt, L. G.; Orloff, J., and Needham, J. W.:  Asymptomatic Hyponatremia in Pulmonary Tuberculosis , J. Clin. Invest. 29: 1545, 1950;.
34 +
Danowski, T. S.: Diabetes Mellitus with Emphasis on Children and Young Adults ,  Ch. 21 , Baltimore, Williams & Wilkins, to be published.
35 +
Farnsworth, E. B.:  Correlation of Excreted Compounds E and F with Clinical Course of a Nephrosis Patient Treated with ACTH and Compounds E and F , abstracted, J. Pharmacol. & Exper. Therap. 110:17, 1954;.
36 +
Deane, H. W.; Shaw, J. H., and Greep, R. O.:  Effect of Altered Sodium or Potassium Intake on Width and Cytochemistry of Zona Glomerulosa of Rat's Adrenal Cortex , Endocrinology 43: 133, 1948;.
37 +
Badinez, O., and Croxatto, H.:  Modifications histológicas de la corteza suprarrenal en la rata provocadas por la administración de cloruro de potasio y cloruro de sodio , Bol. Soc. biol. Santiago 5:40, 1948;.
38 +
Jones, I. C., and Roby, C. C.:  Some Aspects of Zonation and Function of the Adrenal Cortex: I. The Effects of Hypophysectomy on the Adrenal Cortex of the Adult Male Mouse , J. Endocrinol. 10:245, 1954;.

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