RECENT ADVANCES IN THE MANAGEMENT OF RENAL DISEASE IN CHILDREN (PART 1)

THIS REVIEW makes no claim to be exhaustive. In the discussion of topics selected we have not hesitated to make judgments based on our clinical experience when reports give vague or conflicting views. We have given background information when this was felt necessary to make clear the reasons for some aspects of treatment. In cases where there have been no notable recent advances, we have, for the sake of completeness, given brief accounts of currently accepted methods of management. It is hoped that the paper will thus be helpful, not only as a guide to the recent literature, but also in the management of patients. ACUTE GLOMERULONEPHRITIS Before attempting to evaulate recent developments in the management of this disease in children, it is salutary to review some of the results obtained by earlier workers. Frisk and Klackenberg report a 10-year follow-up study of 239 cases of which 230 were typical acute glomerulonephritis. Two hundred fourteen of the patients were located and wherever possible the follow-up examination included recording of blood pressure and an Addis count of the urinary sediment. The survey gave the following results: death during the acute phase, 5 (2.3%); permanent renal damage after 10 years, 12 (5.6%) (8 were symptom-free despite the urinary changes); doubtful urinary findings, 10 (4.7%) (all in good health); completely recovered, 187 (87.4%). Davis and Faber report from California a 2-year follow-up of 102 children which revealed an immediate mortality of 5.9% and an over-all recovery rate of 81.3%. They referred to other series with very similar results.