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[Long-term prognosis in children with minor glomerular abnormalities].
E Kaiserová1, K Furková, I Slugen
1Detská klinika NsP ak. L. Dérera, Bratislava.
Ceskoslovenska Pediatrie
|March 1, 1991
Summary
Treatment improved outcomes for children with minor glomerular abnormalities, reducing relapses and resistant cases. Early treatment in younger children led to more remissions, though relapses can occur for years.
Area of Science:
- Pediatric Nephrology
- Glomerular Diseases
- Clinical Medicine
Background:
- Minor glomerular abnormalities (MGAs) present diverse clinical manifestations in children, including nephrotic syndrome (NS), nephritic syndrome (GN), isolated hematuria (IH), and Schönlein-Henoch's purpura (PSH).
- Prognosis and optimal management strategies for pediatric MGAs require further elucidation.
Purpose of the Study:
- To evaluate the clinical course and long-term prognosis of 109 children diagnosed with minor glomerular abnormalities.
- To assess the effectiveness of treatment interventions, including corticosteroids and immunosuppressants, on disease outcomes.
Main Methods:
- Retrospective analysis of 109 children with biopsy-proven minor glomerular abnormalities.
- Evaluation of clinical presentation, treatment protocols (corticosteroids, immunosuppressants), and long-term outcomes including remission, relapse rates, and renal survival.
- Correlation of morphological findings with clinical activity and prognosis.
Main Results:
- Overall, 88% of children achieved complete remission, with 6% developing chronic renal insufficiency (CRI).
- Treatment significantly reduced relapse rates from a mean of four to one per year and decreased resistant cases from 22% to 10% in the NS group.
- Younger children (<5 years) experienced more relapses but also higher rates of complete remission. Long-term survival in complete remission was 66% after 22 years.
- Outcomes varied by clinical presentation: NS showed significant improvement with treatment, GN had a 47.2% remission rate, PSH achieved 60% remission, and IH had a milder course with no deterioration of renal function in most cases.
Conclusions:
- Prompt and appropriate treatment, including corticosteroids and immunosuppressants, significantly improves the course and prognosis of minor glomerular abnormalities in children.
- Early intervention and management tailored to specific clinical presentations are crucial for optimizing outcomes and preventing chronic renal insufficiency.
- While complete remission is achievable in a majority of cases, long-term monitoring is essential due to the potential for late relapses and the development of chronic kidney disease in a subset of patients.