Hope in Nephrosis

In treating children for the complex kidney ailment of nephrosis, doctors have two common problems in uncommonly severe form: 1) how to decide when a child has the disorder, 2) how to measure the benefit that he gets from treatment. On the first score, most experts call nephrosis not a clear-cut disease but a syndrome, or collection of symptoms: swelling (caused by water retention), which may encompass the whole body, protein in the urine, too little protein and too much fat in the blood. The disorder is commonest in children under ten. usually lasts two to five years, and until recently was fatal in half the cases.

Last week, conceding that not much has been learned about the causes or nature of nephrosis, Columbia University's Dr. Conrad M. Riley told the American Academy of Pediatrics that children with nephrosis are definitely living longer, and the death rate has been cut. Reason: the advent of cortisone and related hormones. Just before the cortisone era opened in 1949, he reported, the chance that a child would live more than four years after the onset of nephrosis was scarcely more than 60%; now it is almost 80%. Dr. Riley's figures were drawn from 14 outstanding hospitals across the U.S.

Details of treatment vary, he found, but results are remarkably uniform. There is no special advantage in giving the master hormone ACTH (which stimulates the adrenals to produce their own hydrocortisone), Dr. Riley believes, and it has the drawback of having to be injected. Better, he suggests, to give "slave hormones"--cortisone or hydrocortisone and some newer variants such as prednisone and prednisolone.

Along with his findings on the latest wonders of steroid chemistry, Dr. Riley gave some down-to-earth suggestions for managing children with nephrosis, who are almost invariably cranky and hard to feed. It does no good, he suggested, to try to enforce absolute rest on a youngster (especially between the ages of two and four). Usually, when they are feeling worse they are least active, so to a great extent this problem solves itself. Also to be avoided: complete isolation in a desperate effort to avoid infection (the emotional damage is greater than the medical benefit), a salt-free diet (it makes a poor appetite worse), rigid control of protein in the diet (there seems to be a self-regulating mechanism that makes children demand more when they need it).

Despite the intensive research, nephrosis is still a quirky baffler. Dr. Riley reported humbly that in two cases all the Doctors' efforts failed during hospitalization, and the children were sent home, still bloated and unimproved. With an assist from a cortisone-type drug three times a week, nature cured them.

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