Vasopressic factors and the development of steroid therapy in nephrosis

Arneil, Gavin C (1960) Vasopressic factors and the development of steroid therapy in nephrosis. PhD thesis, University of Glasgow.

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The nephrotic syndrome which is characterised by capriciousness of course and unpredictability of outcome has long presented a clinical enigma and a therapeutic problem. Bidirectional partition chromatography of urine revealed a peptide excreted by patients with this disease and the like technique showed similar peptides to be present in posterior pituitary extracts. This proved to be active polypeptide fraction of the latter. Attempts to measure the presence of excessive vasopressic activity in plasma of patients led to the use of a very delicate method of biological assay for vasopressin. This procedure was adapted to provide a new method of bio-assay for angiotonin more delicate than those previously available. This investigation led obliquely to the finding of unexplained pressor activity in plasma from hypertensive nephritics, in incubated plasma from normal subjects, and in blood bank plasma. An endeavour was made to establish the clinical pattern and natural history of nephrosis in children. To this end 164 cases who had attended The Royal Hospital for Sick Childre, Glasgow between 1929 and 1957 were traced to 1959 or until death. Much information concerning the natural history of the syndrome was obtained. A number of factors which modified the course and prognosis of the disease were defined and backround against which to assess the value of new forms of therapy was established. In 1951 cortisone and corticotrophin became available for clinical trial. The actions. The actions, side-effects, and toxic effects of these hormones were virtually unknown at this time. Initially short and rather tentative courses of such steroids were given to these nephrotic patients and the effects of treatment on oedema, ascities, proteinuria, serum proteins and electrolytes observed. Conflicting and puzzling results were obtained initially but clarification became possible when 1-hydrocortisone (which possessed much greater glucocorticoid activity relative to sodium retaining power) became available. Since 1956 a series of experimental therapeutic tests with prednisolone, triamcinolone, and dexahetmasone has led to the evolution of effective therapy for nephrosis. Steroid therapy is used in judictions combination with sodium restriction, antibiotic therapy, and with chlorothiazide. This type of treatment is now widely employed and with chlorothiazide. This type of treatment is now widely employed and the significant improvement in the morbidity and mortality of nephrosis which has occurred in recent years may be consequential.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: R EC Wilson
Keywords: Medicine, Pharmacology
Date of Award: 1960
Depositing User: Enlighten Team
Unique ID: glathesis:1960-73639
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 Jun 2019 08:56
Last Modified: 14 Jun 2019 08:56

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