The Prognosis of Nephritis in Childhood With Reference to the Addis Urinary Sediment Count

Giles, Margaret D (1946) The Prognosis of Nephritis in Childhood With Reference to the Addis Urinary Sediment Count. MD thesis, University of Glasgow.

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1. The prognosis was found to differ in the three types of nephritis. The probable ultimate mortality rate was 24.3% in acute haemorrhagic nephritis, 65.3% in the nephrotic syndrome and 100% in the chronic interstitial group. 2. The age and sex of the patient did not affect the prognosis. 3. The longer and the greater the severity of the initial attack, the worse was the prognosis in both the acute nephritic and the nephrotic groups. 4. In acute nephritis, neither the preceding infection nor infectious complications affect the prognosis, nor is there any definite relationship between renal exacerbations and acute infections. In the nephrotic syndrome, infectious complications are the main cause of death, but in a few cases they may be followed by temporary or permanent relief or symptoms. 5. In acute nephritis, cases with slight or moderate oedema at onset had the best prognosis, but in the nephrotic syndrome, the greater the oedema the worse the prognosis. Also a persistently low serum protein or high blood cholesterol indicated a poor prognosis. 6. The non-protein nitrogen of the blood and the blood pressure readings were of no significance in the initial stage of acute nephritis but if either rose in the later stages of any of the three types of nephritis the prognosis was less favourable. 7, Transfusion of concentrated plasma did not give satisfactory results, but did cause disappearance of the oedema in 2 of the 5 cases of nephrotic syndrome treated. There was,however, no resultant improvement in the urinary findings. 8. By giving alkali, it is possible to prolong life in chronic nephritis by combatting the latent acidosis. Those cases with rickets may respond to large doses of vitamins A and 13 and calcium, 9. In acute nephritis, it was found that an average of 110 (a) days (16 weeks) was required for the Addis count to return to normal after the onset of the initial attack. It is suggested that children should be kept in bed or in hospital until the Addis count is normal. The Addis counts were normal in the recovered stage, but raised in the latent and terminal stages. The latent stage, in which the more usual tests were satisfactory, would have been overlooked but for the Addis count, (b )ln the nephrotic syndrome, the occurrence of haematuria was of poor prognosis. The Addis counts were normal in the recovered stage but were raised in 7 of the 8 cases in the latent stage. Six of these cases had had haematuria. In the active and terminal stages, the counts with one exception were raised for all elements although 2 of the 3 cases in the terminal stage had never had haematuria. (c) In chronic nephritis, the 5 eases tested (3 'dwarfs' + 2 'chronic nephritics with hypertension') had raised Addis counts for all elements. Therefore the probable cause of the dwarfism in these 3 cases was renal destruction, not hypoplasia, (10) In both acute nephritis and the nephrotic syndrome, the Addis count is of greater value than any other test in deciding if recovery is complete or if the latent stage exists. It will give evidence of renal damage when other tests show normal function. It is also a valuable confirmatory test in the late stages when evidence of renal failure can be be detected by other means.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1946
Depositing User: Enlighten Team
Unique ID: glathesis:1946-79615
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 31 Mar 2020 09:09
Last Modified: 31 Mar 2020 09:09

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