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[Longitudinal study in children with the nephrotic syndrome and minimal glomerular lesion]
Insights
Idiopathic nephrotic syndrome in children often involves frequent relapses, but early intervention with prednisone and chlorambucil can prolong remission. Careful patient management minimizes severe complications.
Area of Science:
- Pediatric Nephrology
- Internal Medicine
Context:
- Idiopathic nephrotic syndrome (INS) is a significant renal disorder in children.
- Minimal change disease (MCD) is the most common histopathological finding in childhood INS.
Purpose:
- To evaluate the long-term outcomes and relapse patterns in children with INS and MCD.
- To identify predictors of frequent relapses and major complications.
Summary:
- Twenty-one children with INS and MCD were followed for an average of 37 months.
- Frequent relapses were observed in 14 patients, but major complications (peritonitis, septicemia) were rare (2 patients).
- Early disease onset (before age 4), allergic history, hypertension, hematuria, recurrent infections, and rapid relapse post-prednisone predicted frequent relapses.
- Prednisone alone induced remission but not relapse prevention; chlorambucil-prednisone combination therapy lengthened remission periods and reduced relapse rates.
- No definitive predictors for disease duration or late relapses were found, emphasizing the need for ongoing specialized care.
Impact:
- This study highlights the effectiveness of combination therapy in managing frequent relapses of childhood INS.
- It underscores the importance of vigilant monitoring and specialized care to prevent severe outcomes in affected children.
Abstract:
Twenty-one children with idiopathic nephrotic syndrome and minimal changes on renal biopsy were followed during all the disease. The average of follow-up was 37 months, with a range from 12 to 124 months. Recurrent proteinuria was the most important feature during the follow-up; 14 out of the patients showed frequent relapses, but only 2 patients showed major complication (peritonitis, septicemia) during relapses. Frequent relapses appeared most frequently in patients who began the disease before their fourth birthday, showed allergic history, had hypertension and red blood cells in urine, or had recurrent infections and finally, in those where proteinuria reappeared soon after prednisone therapy was ended. Prednisone alone was successful to induce remission, but it did not prevent frequent relapses. The association clorambucil-prednisone allowed lengthening of the period of remission and possibly for this reason the rate of relapses fell during the first 37 months of the follow-up. There are no signs which permit to predict the length of the disease and the frequent relapses can occur even after many years from the beginning of the disease. Special care of these patients avoids major complications.