Journal of the Korean Pediatric Society 1998;41(12):1675-1684.
Published online December 15, 1998.
Long-term Follow-up Study of Children with Minimal Change Nephrotic Syndrome
Jung Sue Kim1, Hae Il Cheong1, Hyun Soon Lee2, Yong Choi1
1Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
2Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea
소아 미세변화 신증후군 : 치료 반응도 및 장기 추적 관찰
김정수1, 정해일1, 이현순2, 최용1
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 해부병리학교실
Correspondence: 
Yong 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.
Key Words: Minimal change nephrotic syndrome, Long-term follow-up


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