THE NEPHROTIC SYNDROME IN ADULTS: A COMMON DISORDER WITH MANY CAUSES
Authors: R M KARK, C L PIRANI, V E POLLAK, R C MUEHRCKE, J D BLAINEY
Journal: Annals of Internal Medicine (1958)

Article1 October 1958THE NEPHROTIC SYNDROME IN ADULTS: A COMMON DISORDER WITH MANY CAUSESROBERT M. KARK, F.A.C.P., F.R.C.P. (Lond.), CONRAD L. PIRANI, M.D., VICTOR E. POLLAK, M.B., M.R.C.P.E., ROBERT C. MUEHRCKE, M.D., JOHN D. BLAINEY, M.D., M.R.C.P.ROBERT M. KARK, F.A.C.P., F.R.C.P. (Lond.)Search for more papers by this author, CONRAD L. PIRANI, M.D.Search for more papers by this author, VICTOR E. POLLAK, M.B., M.R.C.P.E.Search for more papers by this author, ROBERT C. MUEHRCKE, M.D.Search for more papers by this author, JOHN D. BLAINEY, M.D., M.R.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-49-4-751 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe metabolic, nutritional and clinical consequences of continued massive albuminuria constitute the nephrotic syndrome. Florid cases are readily recognized from infancy1, 2to extreme old age,3and the diagnosis can be confirmed rapidly in the laboratory by urinalysis and simple biochemical studies of the blood. The nephrotic syndrome was first described by Richard Bright,4who noted the association of proteinuria, hypoproteinemia and lipemia with edema of renal origin, and it has long been recognized as one manifestation of glomerulonephritis. From our experience with 98 adult patients studied by renal biopsy it is apparent that the syndrome may be due to...Bibliography1. DarmadyStranack EMF: Discussion on the renal tubules. Microdissection of renal tubules, Proc. Roy. Soc. Med. 48: 781, 1955. Google Scholar2. GruskayTurano FLA: Nephrosis in the newborn infant. A syndrome difficult to explain by existing theories of etiology, Arch. Dis. Childhood 94: 117, 1957. Google Scholar3. Ellis A: Natural history of Bright's disease. Clinical, histological and experimental observations. I. Nephritis, Lancet 1: 1, 34, 72, 1942. CrossrefGoogle Scholar4. Osman AA: Original papers of Richard Bright on renal disease, 1937, Oxford University Press, London. Google Scholar5. Roscoe MH: The nephrotic syndrome, Quart J. Med 25: 353, 1956. MedlineGoogle Scholar6. Squire JR: The nephrotic syndrome, in Advances in internal medicine, Vol. 7, edited by Dock, W., and Snapper, I., 1955, Year Book Publishers, Inc., Chicago, page 201. Google Scholar7. HardwickeSquire JJR: Relationship between plasma albumin concentration and protein excretion in patients with proteinuria, Clin. Sc. 14: 509, 1955. MedlineGoogle Scholar8. KalantMacIntyreWilansky NWCDL: Thyroid function in experimental nephrosis, Clin. Res. 6: 39, 1958. Google Scholar9. RecantRiggs LDS: Thyroid function in nephrosis, J. Clin. Investigation 31: 789, 1952. CrossrefMedlineGoogle Scholar10. CartwrightGublerWintrobe GECJMM: Studies on copper metabolism. XI. Copper and iron metabolism in the nephrotic syndrome, J. Clin. Investigation 33: 685, 1954. CrossrefMedlineGoogle Scholar11. GitlinJanewayFarr DCALE: Studies on metabolism of plasma proteins in nephrotic syndrome. I. Albumin, gamma globulin and iron-binding globulin, J. Clin. Investigation 35: 44, 1956. CrossrefMedlineGoogle Scholar12. LuetscherPielCurtis JACFRH: The nephrotic syndrome, J. Chron. Dis. 1: 442, 1955. CrossrefMedlineGoogle Scholar13. SeifterEcker SEE: Complement and isohemagglutinins in urinary proteins, J. Clin. Investigation 25: 809, 1946. CrossrefMedlineGoogle Scholar14. YatzidisRichet HG: Activité de certaines protéines de la coagulation dans le plasma et les urines au cours du syndrome néphrotique, Rev. franc. d'études clin. et biol. 2: 717, 1957. MedlineGoogle Scholar15. VorhausKark LJRM: Serum cholinesterase in health and disease, Am. J. Med. 14: 707, 1953. CrossrefMedlineGoogle Scholar16. LangeCraigObermanSlobodyOgurLoCasto KFJLGF: Changes during the course and treatment of glomerulonephritis, Arch. Int. Med. 88: 433, 1951. CrossrefGoogle Scholar17. ArmstrongKarkSchoenbergerShatkinSights SHRMJAJR: Colloid osmotic pressures of serum proteins in nephrosis and cirrhosis. Relation to electrophoretic distribution and average molecular weights, J. Clin. Investigation 33: 297, 1954. CrossrefMedlineGoogle Scholar18. RosenmanByersFriedman RHSOM: Plasma lipid interrelationships in experimental nephrosis, J. Clin. Investigation 36: 1558, 1957. CrossrefMedlineGoogle Scholar19. SoothillKark JFRM: The effects of infusion of salt-poor human serum albumin on serum cholesterol, cholinesterase and albumin levels in healthy subjects and in patients ill with the nephrotic syndrome, Clin. Res. Proc. 4: 140, 1956. Google Scholar20. RosenmanFriedman RHM: In vivo studies of the role of albumin in endogenous and heparin-activated lipemia-clearing in nephrotic rats, J. Clin. Investigation 36: 700, 1957. CrossrefMedlineGoogle Scholar21. PollakDubinKark VEARM: Unpublished observations. Google Scholar22. Moore JE: Modern treatment of syphilis, 1933, Charles C Thomas, Springfield, Ill., p. 213. Google Scholar23. LandouzyBernard LL: La néphrite parenchymateuse chronique des tuberculeux, Presse méd. 9: 121, 1901. Google Scholar24. Rosenberg M: Die Klinik der Nierenkrankheiten, 1927, S. Karger, Berlin, p. 58. Google Scholar25. Giglioli G: Clinical notes, autopsy and histopathological findings from five fatal cases of quartan malarial nephritis from British Guiana, Tr. Roy. Soc. Trop. Med. and Hyg. 26: 177, 1932. CrossrefGoogle Scholar26. Surbek KE: A striking case of quartana nephrosis, Tr. Roy. Soc. Trop. Med. and Hyg. 25: 201, 1931. CrossrefGoogle Scholar27. Eales L: Personal communication, 1957. Google Scholar28. Squire JR: Personal communication, 1957. Google Scholar29. Rytand DA: Fatal anuria, nephrotic syndrome and glomerular nephritis as sequels of dermatitis of poison oak, Am. J. Med. 5: 548, 1948. CrossrefMedlineGoogle Scholar30. FanconiKousmineFrischknecht GCW: Die konstitutionelle Bereitschaft zum Nephrosesyndrom, Helvet. paediat. acta 6: 199, 1951. MedlineGoogle Scholar31. Rytand DA: Onset of the nephrotic syndrome during reaction to bee sting, Stanford M. Bull. 13: 224, 1955. MedlineGoogle Scholar32. Burch GE: Personal communication, 1956. Google Scholar33. DerowWolff HAL: Oral administration of Mercupurin tablets in ambulatory patients with chronic congestive heart failure, Am. J. Med. 3: 693, 1947. CrossrefMedlineGoogle Scholar34. MunckNissen ONI: Development of nephrotic syndrome during treatment with mercurial diuretics, Acta med. Scandinav. 153: 307, 1956. CrossrefMedlineGoogle Scholar35. WilsonThomsonHolzel VKMLA: Mercury nephrosis in young children with special reference to teething powders containing mercury, Br. M. J. 1: 358, 1952. CrossrefMedlineGoogle Scholar36. Beattie JW: Nephrotic syndrome following sodium bismuth tartrate therapy in rheumatoid arthritis, Ann. Rheumat. Dis. 12: 144, 1953. CrossrefMedlineGoogle Scholar37. Vallery-RadotMauricWolfrommGuiot PGRG: Néphrose lipoïdique secondaire à un traitement aurique, Bull. et mém. Soc. méd. d. hôp. de Paris 58: 96, 1942. Google Scholar38. WeissenbachMartineauBrocardMalinsky RJJJA: Néphrose lipoïdique après chrysothérapie, Bull. et mém. Soc. méd. d. hôp. de Paris 52: 1076, 1936. Google Scholar39. RatheryHurez FA: Néphrose aurique ou néphrose lipoïdique, Bull. et mém. Soc. méd. de hôp. de Paris 52: 1203, 1936. Google Scholar40. BarnettSimonsWells HLDJRE: Nephrotic syndrome occurring during Tridione therapy, Am. J. Med. 4: 760, 1948. CrossrefMedlineGoogle Scholar41. White JC: Nephrosis occurring during trimethadione therapy, J. A. M. A. 139: 376, 1949. CrossrefMedlineGoogle Scholar42. WrenNutt JCRL: Nephrotic syndrome occurring during paramethadione therapy, J. A. M. A. 153: 918, 1953. CrossrefMedlineGoogle Scholar43. Rayer P: Traité des maladies des reins, 1840, Baillière, Paris. Google Scholar44. PollakKarkPiraniShafterMuehrcke VERMCLHARC: Renal vein thrombosis and the nephrotic syndrome, Am. J. Med. 21: 496, 1956. CrossrefMedlineGoogle Scholar45. BlaineyHardwickeWhitfield JDJAG: The nephrotic syndrome associated with thrombosis of the renal veins, Lancet 2: 1208, 1954. CrossrefGoogle Scholar46. SquireBlaineyHardwicke JRJDJ: The nephrotic syndrome, Brit. M. Bull. 13: 43, 1957. CrossrefMedlineGoogle Scholar47. Goodwin JF: Personal communication, 1956. Google Scholar48. Shattock SG: Occlusion of inferior vena cava as a result of internal trauma (dissecting varix?), Proc. Roy. Soc. Med. 6 (Path. Sect.): 126-132, 1913. CrossrefMedlineGoogle Scholar49. PollakPiraniMuehrckeKarkFolli VECLRCRMG: Unpublished observations. Google Scholar50. DerhamRogerson RJMM: The Schönlein-Henoch syndrome with particular reference to renal sequelae, Arch. Dis. Childhood 31: 364, 1956. CrossrefMedlineGoogle Scholar51. MuehrckePiraniPollakKark RCCLVERM: Primary renal amyloidosis with the nephrotic syndrome studied by serial biopsies of the kidney, Guy's Hosp. Rep. 104: 312, 1955. MedlineGoogle Scholar52. Schreiner GE: The differential diagnosis of acute and chronic glomerulonephritis, J. Chron. Dis. 5: 45, 1957. CrossrefMedlineGoogle Scholar53. MuehrckeKarkPiraniPollak RCRMCLVE: Lupus nephritis: a clinical and pathologic study based on renal biopsies, Medicine 36: 1, 1957. MedlineGoogle Scholar54. KimmelstielWilson PC: Intercapillary lesions in glomeruli of kidney, Am. J. Path. 12: 83, 1936. MedlineGoogle Scholar55. LambieMacfarlane ATA: A clinico-pathological study of diabetic glomerulosclerosis, Quart. J. Med. 24: 125, 1954. Google Scholar56. Adams LJ: Renal complications in young diabetics, Canad. M. A. J. 57: 540, 1947. MedlineGoogle Scholar57. HendersonSpragueWagener LLRGHP: Intercapillary glomerulosclerosis, Am. J. Med. 3: 131, 1947. CrossrefMedlineGoogle Scholar58. Reid RT: Nodular glomerulosclerosis. A study of its incidence, morphology, and associated renal lesions in diabetes mellitus, Australasian Ann. Med. 4: 44, 1955. CrossrefMedlineGoogle Scholar59. GellmanPiraniSoothillMuehrckeMadurosKark DDCLJFRCWRM: Structure and function in diabetic nephropathy: the importance of diffuse glomerulosclerosis, Clin. Res. 6: 293, 1958. Google Scholar60. LaipplyEitzenDutra TCOFR: Intercapillary glomerulosclerosis, Arch. Int. Med. 74: 354, 1944. CrossrefGoogle Scholar61. Bell ET: Renal diseases, 2nd Ed., 1950, Lea and Febiger, Philadelphia. Google Scholar62. Wilson C: Personal communication, 1956. Google Scholar63. BloomSeegal WLD: The nephrotic phase: its frequency of occurrence and its differential diagnostic value in determining the nature of the renal lesion in 120 patients who died of renal failure, Ann. Int. Med. 25: 15, 1946. LinkGoogle Scholar64. Longcope WT: Studies of the variations in the antistreptolysin titer of the blood serum from patients with hemorrhagic nephritis. II. Observations on patients suffering from streptococcal infections, rheumatic fever and acute and chronic hemorrhagic nephritis, J. Clin. Investigation 15: 277, 1936. CrossrefMedlineGoogle Scholar65. Müller F: Morbus Brightii, Verhandl. d. deutsch. path. Gesellsch. 9: 64, 1905. Google Scholar66. Munk F: Pathologie und Klinik der Nephrosen, Nephritiden und Schrumpfnieren, 1918, Urban and Schwarzenberg, Berlin. Google Scholar67. VolhardFahr FT: Die Brightsche Nierenkrankheit, 1914, Springer Verlag, Berlin. CrossrefGoogle Scholar68. FarquharVernierGood MGRLRA: Studies on familial nephrosis. II. Glomerular changes observed with the electron microscope, Am. J. Path. 33: 791, 1957. MedlineGoogle Scholar69. FolliPollakReidPiraniKark GVERTCLRM: Electronmicroscopic studies of reversible glomerular lesions in adult nephrotic syndrome, Ann. Int. Med. 49: 775, 1958. LinkGoogle Scholar70. Epstein AA: The nature and treatment of chronic parenchymatous nephritis (nephrosis), J. A. M. A. 69: 444, 1917. CrossrefGoogle Scholar71. BerglundScriverMedes HWdG: Proteinuria and plasma proteins, in Berglund, H., and Medes, G. (ed.): The kidney in health and disease, 1935, Henry Kimpton, London. Google Scholar72. HardwickeSquire JJR: Nephrotic syndrome, Brit. M. J. 1: 875, 1954. CrossrefGoogle Scholar73. Blainey JD: High protein diets in the treatment of the nephrotic syndrome, Clin. Sc. 13: 567, 1954. MedlineGoogle Scholar74. RapoportMcCroryBarberoBarnettFormanMcNamara MWWGHLCWH: Effect of ACTH on children with the nephrotic syndrome, J. A. M. A. 147: 1101, 1951. CrossrefMedlineGoogle Scholar75. LangeSlobodyStrang KLR: Prolonged intermittent ACTH and cortisone therapy in the nephrotic syndrome. Immunologic basis and results, Pediatrics 15: 156, 1955. MedlineGoogle Scholar76. RileyDavisFertigBerger CMRAJWAP: Nephrosis of childhood: statistical evaluation of the effect of adrenocortical-active therapy, J. Chron. Dis. 3: 640, 1956. CrossrefMedlineGoogle Scholar77. LangeStrangSlobodyWenk KRLBEJ: The treatment of the nephrotic syndrome with steroids in children and adults, Arch. Int. Med. 99: 760, 1957. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, Illinois*Presented in part as a Morning Lecture at the Thirty-eighth Annual Session of The American College of Physicians, Boston, Massachusetts, April 12, 1957.From the Departments of Medicine, Presbyterian, Cook County and Research and Educational Hospitals, and the Departments of Pathology and Medicine of the University of Illinois College of Medicine, Chicago, Illinois.Supported in part by contract No. DA-49-007-MD637, Surgeon General's Office, Department of the Army, and grants from the U. S. Public Health Service (H-1029) and the Illinois Chapter of the American Rheumatism Foundation.Requests for reprints should be addressed to Robert M. Kark, M.D., Presbyterian-St. Luke's Hospital, 1753 West Congress Street, Chicago 12, Illinois. 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