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September 1961, Vol 102, No. 3 >
Article | September 1961

A Critical Evaluation of Renal Biopsy in Children FREE

NEIL N. LITMAN, M.D.; CHARLES L. YUILE, M.D.; HARRISON LATTA, M.D.; DONALD GLICKLICH, M.D.; FRED G. SMITH, M.D.
[+] Author Affiliations

Submitted for publication March 3, 1961.

Aided in part by grants from Lederle Laboratories and Ross Laboratories, and a contribution by Mrs. Martha Zaitlin.


Am J Dis Child. 1961;102(3):321-343. doi:10.1001/archpedi.1961.02080010323007.
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References
Comments

Percutaneous renal biopsy has been widely used as a diagnostic procedure. Over 2,000 instances of its use in clinical investigation have been reported, most of these in adults.1-5 The greatest number in children have been reported by Vernier, Good, Worthen, Brunson, and Farquhar,6-17 at the University of Minnesota. Although renal biopsy has offered advantages in research, its practical usefulness is not well established. In order to evaluate the practical value of renal biopsy, we have reviewed our experience gained from light and electron microscopy of renal biopsies performed on 50 children. In this report we have correlated the clinical diagnosis with the pathologic diagnosis and present our assessment of the clinical value of the procedure.

Materials and Method  As a precaution, the first 15 biopsies were performed in the operating room. After being convinced of the safety of the procedure, we used the treatment room of the pediatric

REFERENCES

1 +
Arnold, J. D., and Spargo, B.:  Clinical Use of the Percutaneous Renal Biopsy , Circulation 19: 609, 1959;.
2 +
Brun, C., and Raaschou, F.:  Kidney Biopsies , Amer. J. Med. 24:676, 1958;.
3 +
Kark, R. M.; Muehrcke, R. C.; Pollak, V. E.; Pirani, C. L., and Kiefer, J. H.:  An Analysis of 500 Percutaneous Renal Biopsies , A.M.A. Arch. Int. Med. 101:439, 1958;.
4 +
Brun, C., and Raaschou, F.:  The Results of 500 Percutaneous Renal Biopsies , A.M.A. Arch. Int. Med. 102:716, 1958;.
5 +
Schreiner, G. E., and Berman, L. B.:  Experience with 150 Consecutive Renal Biopsies , Southern Med. J. 50:738, 1957;.
6 +
Vernier, R. L.; Farquhar, M. G.; Brunson, J. G., and Good, R. A.:  Renal Biopsy in the Study of Chronic Renal Disease in Children by Light and Electron Microscopy , Univ. Minn. Med. Bull. 28:58, 1956;.
7 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  An Electron Microscope Study of the Glomerulus in Nephrosis, Glomerulonephritis, and Lupus Erythematosus , J. Exp. Med. 106:649, 1957;.
8 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  The Application of Electron Microscopy in Pathology: Study of Renal Biopsy Tissues , Schweiz. Med. Wschr. 87:501, 1957;.
9 +
Vernier, R. L.; Brunson, J., and Good, R. A.:  Studies on Familial Nephrosis: I. Clinical and Pathologic Study of 4 Cases in a Single Family , A.M.A. J. Dis. Child. 93:469, 1957;.
10 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  Studies on Familial Nephrosis: II. Glomerular Changes Observed with the Electron Microscope , Amer. J. Path. 33:791, 1957;.
11 +
Vernier, R. L.; Farquhar, M. G.; Brunson, J. G., and Good, R. A.:  Chronic Renal Disease in Children , A.M.A. J. Dis. Child. 96:306, 1958;.
12 +
Worthen, H.: Relapse After Prolonged Remission, in Proceedings of the Tenth Annual Conference on the Nephrotic Syndrome, edited by J. Metcoff, New York, National Kidney Disease Foundation, 1958, p. 268.
13 +
Worthen, H. G.; Vernier, R. L., and Good, R. A.:  Infantile Nephrosis , A.M.A. J. Dis. Child. 98:731, 1959;.
14 +
Good, R. A., and Vernier, R. L.:  The Diffuse Renal Diseases of Childhood , Chicago Med. Soc. Bull. 62:468, 1959;.
15 +
Worthen, H. G.; Vernier, R. L., and Good, R. A.:  The Relationship of Renal Morphology to the Response to Treatment and the Prognosis in Idiopathic Nephrosis , Trans. Amer. Pediat. Soc. (May) , 1960;.
16 +
Vernier, R. L.:  Kidney Biopsy in the Study of Renal Disease , Pediat. Clin. N. Amer. 7:353, 1960;.
17 +
Vernier, R. L., and Good, R. A.:  Renal Biopsy in Children , Pediatrics 22:1033, 1958;.
18 +
Muehrcke, R. C.; Kark, R. M., and Pirani, C. L.:  Technique of Percutaneous Renal Biopsy in the Prone Position , J. Urol. 74:267, 1955;.
19 +
Kellow, W. F.; Cotsonas, N. J.; Chomet, B., and Zimmerman, H.-J.:  Evaluation of the Adequacy of Needle-Biopsy Specimens of the Kidney , A.M.A. Arch. Int. Med. 104:353, 1959;.
20 +
Muehrcke, R. C.; Kark, R. M., and Pirani, C. L.:  Biopsy of the Kidney in the Diagnosis and Management of Renal Disease , New Engl. J. Med. 253:537, 1955;.
21 +
Felton, L. M., and Andronaco, J. M.:  Delayed Hemorrhage After Percutaneous Kidney Biopsy , J.A.M.A. 170:2185, 1959;.
22 +
Bergstrand, A.:  Electron Microscopic Investigations of the Renal Glomeruli , Lab. Invest. 6:191, 1957;.
23 +
Bergstrand, A., and Bucht, H.:  Anatomy of the Glomerulus as Observed in Biopsy Material from Young and Healthy Human Subjects , Z. Zellforsch. 48:51, 1958;.
24 +
Rhodin, J.:  Electron Microscopy of the Kidney , Amer. J. Med. 24:661, 1958;.
25 +
Rhodin, J.:  Anatomy of Kidney Tubules , Int. Rev. Cytol. 7:485, 1958;.
26 +
Bonomini, V.:  Renal Hemodynamics, Function and Biopsy in Pyelonephritis: Their Relation to Arterial Hypertension , Urol. Int. (Basel) 8:177, 1959;.
27 +
Schreiner, G. E.:  The Clinical and Histologic Spectrum of Pyelonephritis , A.M.A. Arch. Int. Med. 102:32, 1958;.
28 +
Bell, E. T.: Renal Disease , Philadelphia, Lea & Febiger, 1956;.
29 +
García-Caceres, U.:  Histologic Aspects of Subacute Glomerulonephritis; with Special Reference to Proliferative Alterations in the Epithelium of Renal Tubules , Amer. J. Path. 35:755, 1959;.
30 +
Mann, W. N.:  Bright's Disease: The Changing Concept of a Century , Guy Hosp. Rep. 107:323, 1958;.
31 +
Williams, J. D.:  Some Observations on Renal Biopsy with Reference to Bright's Disease , Guy Hosp. Rep. 107:373, 1958;.
32 +
Burke, E. C.:  Current Practices in General Medicine: 12. Chronic Nephritis in Children: A Diagnostic Enigma , Proc. Mayo Clin. 34:591, 1959;.
33 +
Earle, D. P., and Jennings, R. B.:  Studies of Poststreptococcal Nephritis and Other Glomerular Diseases , Ann. Int. Med. 51:851, 1959;.
34 +
Earle, D. P., and Jennings, R. B.:  Early Manifestations of Nephritis , Med. Clin. N. Amer. 44:59, 1960;.
35 +
Brun, C.; Gormsen, H.; Hilden, T.; Iversen, P., and Raaschou, F.:  Kidney Biopsy in Acute Glomerulonephritis , Acta Med. Scand. 160:155, 1958;.
36 +
Bates, R. C.; Jennings, R. B., and Earle, D. P.:  Acute Nephritis Unrelated to Group A Hemolytic Streptococcus Infection , Amer. J. Med. 23:510, 1957;.
37 +
Russell, E. P., and Smith, N. J.:  Hereditary Hematuria , A.M.A. J. Dis. Child. 98:353, 1959;.
38 +
Ayour, E. M.; Vernier, R. L., and Wannamaker, L. W.:  Streptococcal Antibody Titers in Patients with Chronic Glomerulonephritis , Trans. Amer. Pediat. Soc. , (May) , 1960;.
39 +
Waugh, D., and Frei, J.:  Pulmonary Arteritis, Glomerulonephritis, and Congenital Heart Disease , A.M.A. Arch. Path. 69:427, 1960;.
40 +
Vernier, R. L.: Proceedings of the Tenth Annual Conference on the Nephrotic Syndrome, Edited by J. Metcoff, New York, National Kidney Disease Foundation, 1958, p. 247.
41 +
Hutt, M. S.; Pinniger, J. L., and De Wardener, H. E.:  The Relationship Between the Clinical and the Histological Features of Acute Glomerular Nephritis , Quart. J. Med. 27:265, 1958;.
42 +
Harris, L. D., and McNeil, J. H.:  Recurrent Focal Glomerulitis: A Case Report with Renal Biopsy , Ann. Int. Med. 49:679, 1958;.
43 +
Wedgwood, R. J. P., and Klaus, M. H.:  Anaphylactoid Purpura (Schönlein-Henoch Syndrome) , Pediatrics 16:196, 1955;.
44 +
Allen, D. M.; Diamond, L. K., and Howell, D. A.:  Anaphylactoid Purpura in Children (Schönlein-Henoch Syndrome) , A.M.A. J. Dis. Child. 99:833, 1960;.
45 +
Philpott, M. G., and Briggs, J. N.:  Treatment of the Schoenlein-Henoch Syndrome with Adrenocorticotrophic Hormone (A.C.T.H.) and Cortisone , Arch. Dis. Child. 28:57, 1953;.
46 +
Norkin, S., and Wiener, J.:  Henoch-Schoenlein Syndrome , Amer. J. Clin. Path. 33:55, 1960;.
47 +
Bergstrand, A.; Bergstrand, C. G., and Bucht, H.:  Kidney Lesions Associated with Anaphylactoid Purpura in Children , Acta Paediat. (Upps.) 49:57, 1960;.
48 +
Muehrcke, R. C.; Kark, R. M.; Pirani, C. L., and Pollak, V. E.: Lupus Nephritis , Baltimore, Md., Williams & Wilkins Company, 1957;.
49 +
Pollak, V. E.; Pirani, C. L.; Muehrcke, R. C.; Pulos, P. C.; Kark, R. M., and Steck, I. E.:  On Renal Involvement in Systemic Lupus Erythematosus and Other So-Called Collagen Diseases , Arthritis and Rheumat . 1:204, 1958;.
50 +
Addis, T.: Glomerular Nephritis , New York, The Macmillan Company, 1948;.
51 +
Pollak, V. E.; Pirani, C. L.; Muehrcke, R. C., and Kark, R. M.:  Asymptomatic Persistent Proteinuria: Studies by Renal Biopsies , Guy Hosp. Rep. 107:353, 1958;.
52 +
Kark, R. M.:  Unsuspected Renal Disease Uncovered by Laboratory Examinations , Med. Clin. N. Amer. 44:49, 1960;.
53 +
Goldbloom, R. B.; Fraser, F. C.; Waugh, D.; Aronovitch, M., and Wiglesworth, F. W.:  Hereditary Renal Disease Associated with Nerve Deafness and Ocular Lesions , Pediatrics 20:241, 1957;.
54 +
Sturtz, G. S., and Burke, E. C.:  Hereditary Hematuria, Nephropathy and Deafness , New Engl. J. Med. 254:1123, 1956;.
55 +
 Case Records of the Massachusetts General Hospital (Case 43511) , New Engl. J. Med. 257: 1231, 1957;.
56 +
Perkoff, G. T.; Nugent, C. A., Jr.; Dolowitz, D. A.; Stephens, F. E.; Carnes, W. H., and Tyler, F. H.: A Follow-Up Study of Hereditary Chronic Nephritis, A.M.A. Arch. Int. Med. 102: 733, 1958;.
57 +
Karr, W. J., Jr.:  Fabry's Disease (Angiokeratoma Corporis Diffusum Universale) , Amer. J. Med. 27:829, 1959;.
58 +
Chappell, J. A., and Kelsey, W. M.:  Hereditary Nephritis , A.M.A. J. Dis. Child. 99:401, 1960;.
59 +
Parker, R. A., and Piel, C. F.:  The Nephrotic Syndrome in the First Year of Life , Pediatrics 25:967, 1960;.
60 +
Allen, A. C.:  The Clinicopathologic Meaning of the Nephrotic Syndrome , Amer. J. Med. 18:277, 1955;.
61 +
Smith, F. G., Jr.; Jackson, D.; Latta, H.; Yuille, C., and Litman, N. N.: The Fanconi Syndrome: A Clinico-Pathological Study with Electron Microscopy of the Renal Biopsies of 4 Patients, to be published.
62 +
Richards, W.; Donnell, G. N.; Wilson, W. A., and Stowens, D. S.:  The Oculo-Cerebral-Renal Syndrome of Lowe , Transactions of the American Pediatric Society , (May) , 1960;.
63 +
Leadbetter, W. F.:  Diseases of the Kidney (Surgical) , Ann. Rev. Med. 9:141, 1958;.
64 +
Watt, M. F.; Howe, J. S., and Parrish, A. E.:  Renal Tubular Changes in Acute Glomerulonephritis , A.M.A. Arch. Int. Med. 103:690, 1959;.
65 +
Nesson, H. R., and Robbins, S. L.:  Glomerulonephritis in Older Age Groups , A.M.A. Arch. Int. Med. 105:23, 1960;.
66 +
Vernier, R. L.; Papermaster, B. W.; Olness, K.; Binet, E., and Good, R. A.:  Morphologic Studies of the Mechanism of Proteinuria , Transactions of the Society for Pediatric Research , (May) , 1960;, p. 11
67 +
Amer. J. Dis. Child. 100:476, 1960;.

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References

1 +
Arnold, J. D., and Spargo, B.:  Clinical Use of the Percutaneous Renal Biopsy , Circulation 19: 609, 1959;.
2 +
Brun, C., and Raaschou, F.:  Kidney Biopsies , Amer. J. Med. 24:676, 1958;.
3 +
Kark, R. M.; Muehrcke, R. C.; Pollak, V. E.; Pirani, C. L., and Kiefer, J. H.:  An Analysis of 500 Percutaneous Renal Biopsies , A.M.A. Arch. Int. Med. 101:439, 1958;.
4 +
Brun, C., and Raaschou, F.:  The Results of 500 Percutaneous Renal Biopsies , A.M.A. Arch. Int. Med. 102:716, 1958;.
5 +
Schreiner, G. E., and Berman, L. B.:  Experience with 150 Consecutive Renal Biopsies , Southern Med. J. 50:738, 1957;.
6 +
Vernier, R. L.; Farquhar, M. G.; Brunson, J. G., and Good, R. A.:  Renal Biopsy in the Study of Chronic Renal Disease in Children by Light and Electron Microscopy , Univ. Minn. Med. Bull. 28:58, 1956;.
7 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  An Electron Microscope Study of the Glomerulus in Nephrosis, Glomerulonephritis, and Lupus Erythematosus , J. Exp. Med. 106:649, 1957;.
8 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  The Application of Electron Microscopy in Pathology: Study of Renal Biopsy Tissues , Schweiz. Med. Wschr. 87:501, 1957;.
9 +
Vernier, R. L.; Brunson, J., and Good, R. A.:  Studies on Familial Nephrosis: I. Clinical and Pathologic Study of 4 Cases in a Single Family , A.M.A. J. Dis. Child. 93:469, 1957;.
10 +
Farquhar, M. G.; Vernier, R. L., and Good, R. A.:  Studies on Familial Nephrosis: II. Glomerular Changes Observed with the Electron Microscope , Amer. J. Path. 33:791, 1957;.
11 +
Vernier, R. L.; Farquhar, M. G.; Brunson, J. G., and Good, R. A.:  Chronic Renal Disease in Children , A.M.A. J. Dis. Child. 96:306, 1958;.
12 +
Worthen, H.: Relapse After Prolonged Remission, in Proceedings of the Tenth Annual Conference on the Nephrotic Syndrome, edited by J. Metcoff, New York, National Kidney Disease Foundation, 1958, p. 268.
13 +
Worthen, H. G.; Vernier, R. L., and Good, R. A.:  Infantile Nephrosis , A.M.A. J. Dis. Child. 98:731, 1959;.
14 +
Good, R. A., and Vernier, R. L.:  The Diffuse Renal Diseases of Childhood , Chicago Med. Soc. Bull. 62:468, 1959;.
15 +
Worthen, H. G.; Vernier, R. L., and Good, R. A.:  The Relationship of Renal Morphology to the Response to Treatment and the Prognosis in Idiopathic Nephrosis , Trans. Amer. Pediat. Soc. (May) , 1960;.
16 +
Vernier, R. L.:  Kidney Biopsy in the Study of Renal Disease , Pediat. Clin. N. Amer. 7:353, 1960;.
17 +
Vernier, R. L., and Good, R. A.:  Renal Biopsy in Children , Pediatrics 22:1033, 1958;.
18 +
Muehrcke, R. C.; Kark, R. M., and Pirani, C. L.:  Technique of Percutaneous Renal Biopsy in the Prone Position , J. Urol. 74:267, 1955;.
19 +
Kellow, W. F.; Cotsonas, N. J.; Chomet, B., and Zimmerman, H.-J.:  Evaluation of the Adequacy of Needle-Biopsy Specimens of the Kidney , A.M.A. Arch. Int. Med. 104:353, 1959;.
20 +
Muehrcke, R. C.; Kark, R. M., and Pirani, C. L.:  Biopsy of the Kidney in the Diagnosis and Management of Renal Disease , New Engl. J. Med. 253:537, 1955;.
21 +
Felton, L. M., and Andronaco, J. M.:  Delayed Hemorrhage After Percutaneous Kidney Biopsy , J.A.M.A. 170:2185, 1959;.
22 +
Bergstrand, A.:  Electron Microscopic Investigations of the Renal Glomeruli , Lab. Invest. 6:191, 1957;.
23 +
Bergstrand, A., and Bucht, H.:  Anatomy of the Glomerulus as Observed in Biopsy Material from Young and Healthy Human Subjects , Z. Zellforsch. 48:51, 1958;.
24 +
Rhodin, J.:  Electron Microscopy of the Kidney , Amer. J. Med. 24:661, 1958;.
25 +
Rhodin, J.:  Anatomy of Kidney Tubules , Int. Rev. Cytol. 7:485, 1958;.
26 +
Bonomini, V.:  Renal Hemodynamics, Function and Biopsy in Pyelonephritis: Their Relation to Arterial Hypertension , Urol. Int. (Basel) 8:177, 1959;.
27 +
Schreiner, G. E.:  The Clinical and Histologic Spectrum of Pyelonephritis , A.M.A. Arch. Int. Med. 102:32, 1958;.
28 +
Bell, E. T.: Renal Disease , Philadelphia, Lea & Febiger, 1956;.
29 +
García-Caceres, U.:  Histologic Aspects of Subacute Glomerulonephritis; with Special Reference to Proliferative Alterations in the Epithelium of Renal Tubules , Amer. J. Path. 35:755, 1959;.
30 +
Mann, W. N.:  Bright's Disease: The Changing Concept of a Century , Guy Hosp. Rep. 107:323, 1958;.
31 +
Williams, J. D.:  Some Observations on Renal Biopsy with Reference to Bright's Disease , Guy Hosp. Rep. 107:373, 1958;.
32 +
Burke, E. C.:  Current Practices in General Medicine: 12. Chronic Nephritis in Children: A Diagnostic Enigma , Proc. Mayo Clin. 34:591, 1959;.
33 +
Earle, D. P., and Jennings, R. B.:  Studies of Poststreptococcal Nephritis and Other Glomerular Diseases , Ann. Int. Med. 51:851, 1959;.
34 +
Earle, D. P., and Jennings, R. B.:  Early Manifestations of Nephritis , Med. Clin. N. Amer. 44:59, 1960;.
35 +
Brun, C.; Gormsen, H.; Hilden, T.; Iversen, P., and Raaschou, F.:  Kidney Biopsy in Acute Glomerulonephritis , Acta Med. Scand. 160:155, 1958;.
36 +
Bates, R. C.; Jennings, R. B., and Earle, D. P.:  Acute Nephritis Unrelated to Group A Hemolytic Streptococcus Infection , Amer. J. Med. 23:510, 1957;.
37 +
Russell, E. P., and Smith, N. J.:  Hereditary Hematuria , A.M.A. J. Dis. Child. 98:353, 1959;.
38 +
Ayour, E. M.; Vernier, R. L., and Wannamaker, L. W.:  Streptococcal Antibody Titers in Patients with Chronic Glomerulonephritis , Trans. Amer. Pediat. Soc. , (May) , 1960;.
39 +
Waugh, D., and Frei, J.:  Pulmonary Arteritis, Glomerulonephritis, and Congenital Heart Disease , A.M.A. Arch. Path. 69:427, 1960;.
40 +
Vernier, R. L.: Proceedings of the Tenth Annual Conference on the Nephrotic Syndrome, Edited by J. Metcoff, New York, National Kidney Disease Foundation, 1958, p. 247.
41 +
Hutt, M. S.; Pinniger, J. L., and De Wardener, H. E.:  The Relationship Between the Clinical and the Histological Features of Acute Glomerular Nephritis , Quart. J. Med. 27:265, 1958;.
42 +
Harris, L. D., and McNeil, J. H.:  Recurrent Focal Glomerulitis: A Case Report with Renal Biopsy , Ann. Int. Med. 49:679, 1958;.
43 +
Wedgwood, R. J. P., and Klaus, M. H.:  Anaphylactoid Purpura (Schönlein-Henoch Syndrome) , Pediatrics 16:196, 1955;.
44 +
Allen, D. M.; Diamond, L. K., and Howell, D. A.:  Anaphylactoid Purpura in Children (Schönlein-Henoch Syndrome) , A.M.A. J. Dis. Child. 99:833, 1960;.
45 +
Philpott, M. G., and Briggs, J. N.:  Treatment of the Schoenlein-Henoch Syndrome with Adrenocorticotrophic Hormone (A.C.T.H.) and Cortisone , Arch. Dis. Child. 28:57, 1953;.
46 +
Norkin, S., and Wiener, J.:  Henoch-Schoenlein Syndrome , Amer. J. Clin. Path. 33:55, 1960;.
47 +
Bergstrand, A.; Bergstrand, C. G., and Bucht, H.:  Kidney Lesions Associated with Anaphylactoid Purpura in Children , Acta Paediat. (Upps.) 49:57, 1960;.
48 +
Muehrcke, R. C.; Kark, R. M.; Pirani, C. L., and Pollak, V. E.: Lupus Nephritis , Baltimore, Md., Williams & Wilkins Company, 1957;.
49 +
Pollak, V. E.; Pirani, C. L.; Muehrcke, R. C.; Pulos, P. C.; Kark, R. M., and Steck, I. E.:  On Renal Involvement in Systemic Lupus Erythematosus and Other So-Called Collagen Diseases , Arthritis and Rheumat . 1:204, 1958;.
50 +
Addis, T.: Glomerular Nephritis , New York, The Macmillan Company, 1948;.
51 +
Pollak, V. E.; Pirani, C. L.; Muehrcke, R. C., and Kark, R. M.:  Asymptomatic Persistent Proteinuria: Studies by Renal Biopsies , Guy Hosp. Rep. 107:353, 1958;.
52 +
Kark, R. M.:  Unsuspected Renal Disease Uncovered by Laboratory Examinations , Med. Clin. N. Amer. 44:49, 1960;.
53 +
Goldbloom, R. B.; Fraser, F. C.; Waugh, D.; Aronovitch, M., and Wiglesworth, F. W.:  Hereditary Renal Disease Associated with Nerve Deafness and Ocular Lesions , Pediatrics 20:241, 1957;.
54 +
Sturtz, G. S., and Burke, E. C.:  Hereditary Hematuria, Nephropathy and Deafness , New Engl. J. Med. 254:1123, 1956;.
55 +
 Case Records of the Massachusetts General Hospital (Case 43511) , New Engl. J. Med. 257: 1231, 1957;.
56 +
Perkoff, G. T.; Nugent, C. A., Jr.; Dolowitz, D. A.; Stephens, F. E.; Carnes, W. H., and Tyler, F. H.: A Follow-Up Study of Hereditary Chronic Nephritis, A.M.A. Arch. Int. Med. 102: 733, 1958;.
57 +
Karr, W. J., Jr.:  Fabry's Disease (Angiokeratoma Corporis Diffusum Universale) , Amer. J. Med. 27:829, 1959;.
58 +
Chappell, J. A., and Kelsey, W. M.:  Hereditary Nephritis , A.M.A. J. Dis. Child. 99:401, 1960;.
59 +
Parker, R. A., and Piel, C. F.:  The Nephrotic Syndrome in the First Year of Life , Pediatrics 25:967, 1960;.
60 +
Allen, A. C.:  The Clinicopathologic Meaning of the Nephrotic Syndrome , Amer. J. Med. 18:277, 1955;.
61 +
Smith, F. G., Jr.; Jackson, D.; Latta, H.; Yuille, C., and Litman, N. N.: The Fanconi Syndrome: A Clinico-Pathological Study with Electron Microscopy of the Renal Biopsies of 4 Patients, to be published.
62 +
Richards, W.; Donnell, G. N.; Wilson, W. A., and Stowens, D. S.:  The Oculo-Cerebral-Renal Syndrome of Lowe , Transactions of the American Pediatric Society , (May) , 1960;.
63 +
Leadbetter, W. F.:  Diseases of the Kidney (Surgical) , Ann. Rev. Med. 9:141, 1958;.
64 +
Watt, M. F.; Howe, J. S., and Parrish, A. E.:  Renal Tubular Changes in Acute Glomerulonephritis , A.M.A. Arch. Int. Med. 103:690, 1959;.
65 +
Nesson, H. R., and Robbins, S. L.:  Glomerulonephritis in Older Age Groups , A.M.A. Arch. Int. Med. 105:23, 1960;.
66 +
Vernier, R. L.; Papermaster, B. W.; Olness, K.; Binet, E., and Good, R. A.:  Morphologic Studies of the Mechanism of Proteinuria , Transactions of the Society for Pediatric Research , (May) , 1960;, p. 11
67 +
Amer. J. Dis. Child. 100:476, 1960;.

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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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