| Long Term Follow-up Study of Chidren with nephrotic Syndron (over 5years). |
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Hae Il Cheong, Whan Chong Lee, Yong Choi, Cwang wook Ko |
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Department of Pediayrics, College of Medicine, Seoul Nattional University, Korea. |
| 腎症候群 患兒의 長期追跡考察 (5年以上) |
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丁海日, 李換鍾, 崔 鏞, 高光昱 |
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서울大學校 醫科大學 小兒科學敎室 |
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| Abstract |
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Follow-up study of fifty two children with nephrome who had once admitted to the pediatric ward of S.N.U.H were presented with regards to response to initial steroid therapy, relapsing patterns, and factors affecting prognosis. All patients were followed up for more than 5 years and the mean period of follow-up was 7 7/12 years, and in two patients, follow-up for more than 10 years was made. The mean age of onset was 6 4/12 years, and male to female ratio was 5.5 to 1. With initial steroid therapy, complete remission was achieved in 37 patients(71.2%), partial remission in 14 patients(23.1%), and 1 patient(1.9%) was resistant to the therapy. Of 12 patients with residual proteinuria, loss of the residual proteinuria was observed after mean duration of 9 months in 10 patients, and in the remaining 2 patients, residual proteinuria didn't disappear in the follow-up period. Nineteen of 52 patients(36.5%) didn't relapse in the follow-up period after initial steroid bherapy, and 28 of 52 patients(53.8%) relapsed during the 1st year follow-up, and of the remaining 24,4 patients(16.7%) relapsed during the 2nd year follow-up, and of the remaining 20 patients who didn't relapse for 2 years, 19 patients remained continuously in remission in all the follow-up period, and only 1 patient relapsed during 5th year follow-up. Upper respiratory infections were associated with 41% of total relapses. Usually, the response to the steroid therapy in subsequent relapses was same as the response in inintial episode. Findings of nephritis, such as hematuria, azotemia, and hypertension at the onset of illness were observed in 17.3%, 23.1%, and 23.1% of the 52 patients respectively, and these findings were observed more frequently in patient who could't achieve complate remission with initial steroid therapy and correlated with a less favorable outcome. Duration of illness before institution of steroid therapy had no influence in the response to steroid therapy and prognosis. Between relapsing and non-relpsing patients in completely remitted patient group, there were no difference in age of onset, duration of illness before institution of steroid therapy, average duration until loss of proteinuria, and average duration until onset of diuresis. But, findings of nephritis were found more frequently in relapsing patients. In completely remitted patient group, proteinuria disappeared in the 1st week in 23.4%, and within the 2nd week in 67.6%. The percentage of those exhibiting a relapsing course decreased progressively with each year of follow-up, but 25% were still relapsing five year after onset of the nephrotic syndrome. One patient expired at the follow-up period of 6 4/12 years due to progressive chronic renal failure. In some patients who received longterm steroid therapy, mild side effects were found, but there was no serious one except one case of steroid pschosis. Percutaneous kidney needle biopsy was done in 8 cases of frequent relapsers and poor responders. |
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