Adult Minimal Change Nephrotic Syndrome: Treatment Response and Relapse

Park, Jung Hwan; Heo, Nam Ju; Lee, Jung Pyo; Park, Dong Jun; Seong, Eun Young; Joo, Kwon Wook; Lim, Chun Soo; Kim, Yon Su; Ahn, Curie; Han, Jin Suk; Kim, Suhnggwon; Lee, Jung Sang

Abstract

BACKGROUND
Minimal change nephrotic syndrome (MCNS) is the most common cause of idiopathic nephrotic syndrome in Korea, not only in children but also in adults. METHODS: We reviewed the medical records of patients older than 16 years who were diagnosed MCNS by percutaneous renal biopsy between 1979 and 2002 and followed more than 6 months there after. RESULTS: Of total 94 patients enrolled, there were 58 men and 36 women (male to female 1.6: 1), the mean age of onset was 30.5 (16-73) years, and the mean follow-up period was 66 (6-297) months. Of 81 patients who were initially given corticosteroid, complete remission (CR) was observed in 68 (84%), partial remission in 7 (8.6%), and failure to remission in 6 (7.4%). In comparison of the 47 patients who showed CR by the 4th week with the group who showed CR after 4 weeks plus who did not show CR after all, male (p=0.04) and renal insufficiency (p=0.01) were more dominant in the latter group. All of 10 patients who were initially given the combination of cyclophosphamide and corticosteroid showed CR. The mean number of relapse per patient per year was 0.37 in 79 patients who achieved CR with initial treatment, 0.44 in 61 patients younger than 40 years, and 0.15 in 18 patients older than 40 years (p=0.02). Remission was maintained longer in patients older than 40 years (p=0.005), and in those with proteinuria less than 10 grams per day (p=0.04). CONCLUSION: Among patients with MCNS, those who presented with initial renal insufficiency show a less favorable response to corticosteroid. Patients older than 40 years show less frequent relapse and longer duration of remission.