Adult Minimal Change Nephrotic Syndrome (MCNS): Treatment and A Long-term Follow-up

Song, H C; Song, H J; Kim, Y O; Shin, S Y; Park, C H; Jin, D C; Kim, S Y; Choi, E J; Chang, Y S; Bang, B K

Abstract

OBJECTIVE
MCNS is common type of nephrotic syndrome in adult. Clinically, MCNS is characterized by a pure, often severe nephrotic syndrome and proteinuria may persistent for many years. 60-70% of them respond to corticosteroids and renal prognosis is excellent but response rate renal prognosis seem to be worse in adult. Therefore we performed this study to evaluate the clinical factors which influence the responses to treatment and result of follow-up.
METHODS
Between 1987 May and 1995 September, we reviewed 101 adult-onset necrotic syndrome patients with minimal change on renal biopsy, and all were treated with corticosteroids as initial therapy.
RESULTS
There are no significant difference in serum albumin, serum creationism, hypertension, microscopic hematuria, creatinine clearance, proteinuria compared with age group(<30 yrs, 30-50 yrs, >50 yrs). After the 16 weeks course of prednisolone, 74 of the 101 patients were in complete remission. Among the patients who were in complete remission, 45 patients were relapsed and mean duration of remission was 25 weeks(range: 2-155 weeks), In multivariate analysis microscopic hematuria(p=0.007) was independent risk factor of partial and non-response to corticosteroids. Cyclophosphamide was used in 28 patients, usually in a course of 8 weeks(frequent relapse 10, steroid resistance 17, steroid dependent 1). Among the them 21 patients(75%) showed complete remission within S weeks and duration of remission after cyclophosphamide was not different from after prednisolone(39+/-41 vs. 26+/-30, p=NS). For follow-up of renal function in 44 patients(mean 46 month, 24-76 month), only 1 patient's serum creatinine level was double compared with initial serum creatinine level and only 1 case of death was observed.
CONCLUSION
In adult MCNS, microscopic hematuria at initial presentation were independent risk factor of partial or non-response to corticosteroids therapy. Renal function deterioration and death associated with complication of nephrotic syndrome and treatment are very rare.