II. Laboratory Findings in One Hundred Six Instances

Abstract

In a previous report we have described the clinical results and the changes in proteinuria in a total of 106 instances of nephrotic syndrome in children treated, usually for 28 days, with corticotropin (ACTH),* 100 to 200 units per day, a very low-sodium high-potassium diet, and penicillin.1 The alterations in the formed elements of the blood, in serum and blood solutes, and in urinary reducing substances and 17-ketosteroids prior to, during, and following therapy are herein presented. Materials and MethodsErythrocyte, leukocyte, and differential blood cell counts; the hemoglobin content; the levels of whole-blood nonprotein nitrogen and sugar; the presence of reducing substances in the urine (Benedict's test) ; the concentrations of carbon dioxide, chloride, sodium, potassium, total protein, albumin, globulin, calcium, inorganic phosphorus, and cholesterol in serum, and the 24-hour excretion rates of urinary 17-ketosteroids were measured at approximately weekly intervals before, during, and after therapy by methods in regular use in this and other laboratories.2,3In Table 1 the mean erythrocyte, hemo¬ globin, total leukocyte, polymorphonuclear, and lymphocyte counts; the ranges of these values, and the number of observations prior to, during, and following cortico¬ tropin therapy have been recorded. Posi¬ tive findings were limited to a leukocytosis characterized by an increase in polymorpho¬ nuclear cells and metamyelocytes and a decrease in lymphocytes.4'5 This began dur¬ ing the first week and became maximal dur¬ ing the second, third, and fourth weeks of therapy. The highest leukocyte count ob¬ served was 28,000, and the polymorphonu¬ clears rose as high as 96% in patients without infection or any side-reaction or complication while on corticotropin. Though not included in the Table, the same trend and the same magnitude of change were noted in the patients in whom interruption of corticotropin was necessary or deemed advisable for one reason or another.1 These changes disappeared during the first or the second week following withdrawal of the hormone in both the uninterrupted and interrupted groups.Comment. Only occasional patients were admitted with elevations in the polymorpho¬ nuclear leukocyte count. The trend noted during treatment is in keeping with the well-recognized leukocytosis and lymphopenia evoked by corticotropin alone.