| Follow-up Study of Children with Nephrotic Syndrome |
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Jeong Kee Seo, Yong Choi, Kwang Wook Ko |
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Department of Pediatrics, Seoul National University Hospital |
| 腎症候群 患兒의 追跡考察 |
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徐延琪, 崔 鑛, 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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Forty seven children with nephrotic syndrome were studied. No specific cause for nephrotic syndrome was found in all children except one with tridione induced nephrotic syndrome. Response to the initial continuous steroid therapy, relapsing patterns and factors affecting prognosis were evaluated in this study. All patients were followed up for more than 3 years. The mean period of observation was 4.9 years(Table 2). In 2 patients, follow-up period was 12 years which was the longest one. The mean age of onset was 5.9 years. Most of them(70
%) were under 7 years of age at onset(Table 1). Male to female ratio was 5.7 to 1. Complete remission was observed in 31 children(66%) after initial continuous steroid therapy (prednisone 60mg/m2/day for 2~4weeks) (Table 3). Incomplete remission in which mild biochemical abnormality and proteinuria were still present
after initial continuous steroid therapy was observed in 13 patients(27.6%). But biochemical abnormality and residual proteinuria returned to normal within subsequent several months. (Table 4). Three patients(6.4%) were resistant to steroid therapy. Eighteen of 44 patients(41%) didn’t relapse in the follow-up period after initial remission. Twelve of 44 patients(27%) relapsed during the first year follow up. Of the remaining 32, 7 patientsC22%) relapsed during the 2 nd year follow up. Of the remaining 25, 6 patiems(24%) relapsed during the third year follow-up. Most relapsing patients relapsed once or twice(Table 8). Upper respiratory infection was frequently associated with relapses(Table 7). Children responsive to initial continuous steroid treatment continued to have the same patterns of response in subsequent relapses.Hematuria, hypertension and azotemia were observed in 14.9%, 17.0% and 27.6% of the 47 patients respectively. These findings at the onset of illness were present more frequnetly in patients with poor steroid response and incompletely remitted patients than in patients with complete remission and its presence during the first episode of nephrosis correlated with a less favorable initial steroid response and outcome (Table 9). Duration of illness before institution of prednisone therapy had no influences on the response to prednisone therapy or outcome(Table 10). Between relapsing and non relapsing patients, there are no difference in age at onset, duration of illness before institution of streoid therapy, average duration until loss of proteinuria. (Table 11). One of the nephritis symptomsChematuria, hypertension, azotemia was found in 5 of 19 relapsing patients. However any of the non relapsing patients didn’t show these symptoms. In completely remitted patient group, proteinuria disappeared mostly(84%) after 2 weeks of prednisone therapy(Table 12). In four patients chronic renal insufficiency developed progressively and two of them expired at the follow-up period of 7.5 years, 4.2 years respectively. Obesity, Cushingoid face, hirsutism, incresased appetite, mild growth retardation, osteoporosis were observed in some of the patients who recieved long term prednisone therapy. However, these were mild and none of these children showed serious steroid side effects. |
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