| Clinical Studies of Nephrotic Syndrome in Children. |
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Soon Pyo Chung, Pyung Do Nam, Yeo Sook Koh, Kew Taek Kim |
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Dept of Pediatrics, St. Benedict Hospital, Busan, Korea. |
| 腎症候群 患兒의 臨床的 考察 |
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鄭淳約, 南炳道, 高麗淑, 金奎宅 |
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釜山聖芬道病院 小兒科 |
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| Abstract |
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The authors observed thirty two cases of nephrotic syndrome admitted at Pediatric Department of St. Benedict Hospital, Busan, Korea. No specific cause for nephrotic syndrome was found in all patients. Respnse to the initial continuous steroid therapy, relapsing patterns and onset of diuresis between steroid only and steroid combined with furosemide especially in severely illed patients were evaluated in this study. The mean period of observation was 3.2 years. 1) The mean age of onset was 7.1 years. Most of them(97%) showed under the 10 years of age at onset. The ratio of male and female was 4.3 to 1. The seasonal incidence showed prevalence from September to October (31%). 2) Upper respiratory infection (21.9%) was the most common associated infection at onset. 3) Complete remission was showed in 23 children (71.8%) after initial continuous steroid therapy. Partial remission in which mild biochemical abnormalities and residual proteinuria wer still present after initial continuous steroid therapy was showed in 6 patients (18.8%), but biochemical abnormalities and residual proteinuria returned to normal within subsequent several months. Three patients (9.4%) were restant to initial steroid therapy. 4) Proteinuria abolished in most of them (87.4%) after 3 weeks of prednisolone therapy in complete remitted patient group, and also abolished after not more than 6 months treatment and their subsequent course in partial remitted patient group. 5) 10 patients (45.4%) had an episode of relapses more than one time, though most of them once or twice, 7 patients (31.8%) relapsed at first year and 2 patients (9%) at second year of follow up period. 6) Steriod responsiveness in relapsing cases was the same as first attack except one. 7) Hematuria, hypertension and transient azotemia were observed in 18.7%, 18.7% and 21.8% of he 32 patiets respectively. These findings at onset of illness were present more frequently in patients with poor steroid response and partial remitted patients than with complete remitted patients, and these episodes were also obtained to correlation with a less favorable initial steroid response and outcome. 8) Duration of illness before institution of steroid therapy had no influences on the steroid response. 9) Diruesis was achieved by 5.2 days in group steroid only and by 4.8 days in group of steroid combined with furosemide, 1~2mg/kg/day, p.o. 10) Two cases were remitted after combined therapy with cyclophosphamide (2mg/kg/day for 4~8 weeks) and prednisolone (60mg/m(2)/day as a single dose on alternate days). One of them was early steroid resistant patient and the other frequent relapsing patient. 11) In one patient, chronic renal insufficiency developed progressively during the follow up period. The other one, whohad no responsiveness to initial steroid therapy and youngest at onset, expired with itercurrent infection. |
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