J Korean Pediatr Soc.  1998 Dec;41(12):1675-1684.

Long-term Follow-up Study of Children with Minimal Change Nephrotic Syndrome (MCNS)

• Kim JS
• Cheong HI
• Lee HS
• Choi Y

Abstract

PURPOSE: Most of childhood MCNS has a long disease course with frequent relapses. This study was designed to analyze the long-term clinical course of childhood MCNS, focusing at relapsing pattern, treatment response and complications. Mothods : The medical records of 137 children with biopsy-proven MCNS observed during 1976 ti 1996 were analyzed retrospectively. They were classified as initial responders (111 patients, 81%) and nonresponders (26 patients, 19%) according to the response to initial oral prednisolone (60mg/m2/d) for 4 weeks. The detailed clinical courses were obtained in 126 patients.
RESULTS
The incidences of hematuria, hypertension and azotemia were more frequent in initial responders than nonresponders. During follow-up, the proportion of patients with sustained remission increased gradually with decreasing rate of relapse. At the last follow-up, 77 patients (61%) revealed sustained remission, 36 (29%) repeated relapses, 9 (7%) persistent proteinuria, 3 (2%) renal failure, and 1 (1%) death. The responses to secondary drugs such as first and second course of cyclophosphamide, cyclosporin, levamisole and methylprednisolone pulse were 80%, 85.7%, 70%, 75%, and 40%, respectively. Major complications were infections including peritonitis (29 patients) and acute renal failure (10) patients.CONCLUSION: Long-term prognosis of childhood MCNS is determined by clinical courses rather than renal pathology. Although majority of childhood MCNS reveal good long-term prognosis, patients did well, few patients do not so. Early detection and more aggressive therapy of such patients are very helpful.

Keyword

Minimal change nephrotic syndrome; Long-term follow-up

MeSH Terms

Acute Kidney Injury
Azotemia
Child*
Cyclophosphamide
Cyclosporine
Follow-Up Studies*
Hematuria
Humans
Hypertension
Incidence
Levamisole
Medical Records
Methylprednisolone
Nephrosis, Lipoid*
Pathology
Peritonitis
Prednisolone
Prognosis
Proteinuria
Recurrence
Renal Insufficiency
Retrospective Studies
Cyclophosphamide
Cyclosporine
Levamisole
Methylprednisolone
Prednisolone