Previous observations of the effect of dietary protein,1 fat and carbohydrate2 on the nitrogen balance of young children with the nephrotic syndrome revealed the fact that protein intakes above the optimum of 3 Gm. daily per kilogram of body weight tended to produce a less positive or even a negative nitrogen balance in these children. There still remained unexplained fluctuations in the nitrogen balance unrelated to diet and in the absence of infection.
It is well known that nephrotic children are susceptible to acute infections, particularly pneumococcic peritonitis. MacLeod and Farr3 found that these attacks are usually due to infection not by freshly acquired organisms but by organisms which have been carried for some time. The infections appear to result primarily from some metabolic disturbance, as a result of which resistance is lowered and a previously harmless organism invades the blood and the peritoneal fluid.
FARR LE. ASSIMILATION OF PROTEIN BY YOUNG CHILDREN WITH THE NEPHROTIC SYNDROMEIII. EFFECT OF NEPHROTIC CRISES ON ASSIMILATION OF NITROGEN. Am J Dis Child. 1939;58(5):939-948. doi:10.1001/archpedi.1939.01990100021003