Two infants are described who developed renal tubular and papillary necrosis. In one, severe problems of management occurred during the diuretic phase. In the other, the intravenous pyelogram showed characteristic changes during the acute illness. The urinary findings are compared with those in other dehydrated infants and a means of early diagnosis is suggested. In a dehydrated infant an initial urine sodium of more than 100 mEq/l., the persistence of osmolality below 500 mOsm/kg, and urea below 1500 mg/100 ml suggest renal tubular damage.
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