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Children requiring acute dialysis are best catered for in units with wide experience of both dialysis and children. This is likely to be the paediatric unit of a regional hospital which has a renal unit. A few of these centres should be planned as area dialysis and transplant centres for children with chronic renal failure. Ideally, the unit should be sited close to the adult dialysis centre and to the paediatric wards. Full paediatric staffing will be required, with combined supervision by paediatrician and renal physician.

Barbitone was found in concentrations of 0·24-1·32 mg. per 100 ml. in the blood of six patients on regular haemodialysis. None of the patients had apparently taken the drug, but all had taken other barbiturates. Barbitone was not found in plasmas from five patients on dialysis who had not taken any barbiturates, or from a patient taking phenytoin. Contamination of the pentobarbitone capsules used by 0·1-0·2% barbitone was the most likely source. Some barbitone was found in all of twenty samples of pentobarbitone from different manufacturers. Accumulation seemed to depend upon strong binding of the barbitone to plasma-proteins, principally albumin, which was demonstrated both in vitro and in vivo. This binding reduced the dialysance of barbitone in standard Kiil dialysis by 50%. The accumulation of normally insignificant contaminants or metabolites in patients with renal failure or on dialysis must be considered.

Data from 109 patients in established Summary acute renal failure, referred during the period January, 1969, to April, 1971, have been analysed. Mortality in this group of patients was distressingly high (57%) despite intensive dialysis and intensive general care. Sepsis still remains a major problem both as a precipitating and complicating factor in acute renal failure. Milder forms of renal failure were rarely referred to the unit during this period; most patients being older, more severely ill, and with prolonged oliguria. Since mortality increases with age, irrespective of precipitating cause, the greater age of the series probably accounts for much of the high mortality. Survival from acute renal failure in old patients who had just had surgical operations was rare, and it is in this area that most remains to be done. 29 patients with urine hypo-osmolar or isoosmolar plasma were given frusemide 500 mg. or 250 mg. intravenously; only 7 showed a diuresis, and this was sustained in only 3.

A planned attempt to induce immunological enhancement of a transplanted kidney in an eight-year-old child is described. Antiserum for enhancement was prepared by immunising the patient's father with the leucocytes of the mother, who was the graft donor. Fab and [F(ab') 2 ] derived from the antiserum was administered to the patient at operation and shortly afterwards. Low doses of immunosuppressive drugs were also given. When graft function had been established postoperatively, all immunosuppressive therapy was withdrawn. The kidney graft continued to function satisfactorily for three months without further immunosuppression being required. The results suggest that a partial state of enhancement has been obtained, and that the potential value of this treatment is very great.