All issues > Volume 41(12); 1998

Original Article

J Korean Pediatr Soc. 1998;41(12):1675-1684. Published online December 15, 1998.

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

Jung Sue JS Kim¹, Hae Il HI Cheong¹, Hyun Soon HS Lee², Yong Y Choi¹

¹Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
²Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea

Correspondence Yong Y Choi ,Email: 1

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).
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.

Keywords :Minimal change nephrotic syndrome, Long-term follow-up