THE EFFECT OF ADRENOCORTICOTROPHIC HORMONE ON CHILDREN WITH THE NEPHROTIC SYNDROME. II. PHYSIOLOGIC OBSERVATIONS ON DISCRETE KIDNEY FUNCTIONS AND PLASMA VOLUME 1

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Abstract
Profuse, sustained diureses occurring at predictable times in a high percentage of trials during or following admn. of ACTH to children with the nephrotic syndrome permitted observations on changes which may accompany and be involved in the mechanism of diuresis. Serial measurements of discrete kidney functions and plasma volume are reported before, during and after 13 such diureses in 8 children. The results indicate: (1) In 9 observations where inulin clearances were measured before and after the outset of diuresis, significant increases (50-256% above control values) were observed in 6. (2) Daily 24-hr. creatinine clearances, measured in one of the 3 instances in which no marked increase in inulin clearance was observed after diuresis, suggest that glomerular filtration rate did increase during diuresis. Repeated responses in children with reduced function may be associated with a progressive increase to normal or even "supernormal" values. (3) A consistent decrease in the endogenous creatinine: inulin clearance ratio was observed as glomerular filtration rate increased. However, clearances of thiosulfate and inulin showed reasonably good agreement at both high and low rates of glomerular filtration. (4) Clearances and maximum tubular excretion of p-amino-hippurate increased during diuresis, but proportionately less than inulin clearances. Consequently, increases in the Cin:CpaH and the CIN:TmpaH ratios were observed as rates of glomerular filtration increased. (5) In 4 of 5 observations on 5 children, increases in plasma volume (T-1824) ranging from 11 to 29% above control values were observed during diureses.