Long-term prognosis of idiopathic nephrotic syndrome in children

Figures & data

Table 1. Tune–Mendosa protocol.

Weeks	IV. Pulse methylprednisolone (maximum dose:1 g/day)	Oral prednisolone (maximum dose 60 mg/day)
1–2	30 mg/kg/1 week
3–10	30 mg/kg/1 week	1.5 mg/kg/Eod
11–18	30 mg/kg/2 weeks	1 mg/kg/Eod
19–50	30 mg/kg/1 month	0.5 mg/kg/Eod
51–82	30 mg/kg/2 months	0.5 mg/kg/Eod

Note: Eod: every other day.

Table 2. Clinical and laboratory findings of patients at first presentation.

Clinical finding	Number of patients	(%)
Edema	390	99.5
Localised	159	40.8
Generalised	231	59.2
Infection	235	59.9
LRTI	102	43.4
URTI	86	36.6
UTI	60	25.5
Peritonitis	22	9.4
Gastroenteritis	14	5.9
Cellulitis	8	3.4
Other	7	2.8
More than one infection	49	20.8
Hypertension	45	11.5
Hepatomegaly	27	6.9
Rash	1	0.3
Hyperlipidemia	160/190	84.2
Hematuria	107	27.3
Microscopic	104	26.5
Macroscopic	3	0.8
Renal failure	3	0.8

Notes: LRTI: lower respiratory tract infection, URTI: upper respiratory tract infection, UTI: urinary tract infection.

Figure 1. Initial response of the patients to steroid therapy.

Figure 2. Response to immunosupressive treatments in children with steroid dependent or frequently relapsing nephrotic syndrome.

Table 3. Renal biopsy findings of patients according to steroid response.

Steroid response	MCD	FSGS	DMP	Total
SSNS	7 (43.7%)	5 (31.3 %)	4 (25%)	16
SRNS	6 (11.7%)	36 (70.6%)	9 (17.7 %)	51
SDNS/FR	2 (33.3%)	1 (16.7%)	3 (50%)	6
Total number (%)	15 (20.6%)	42 (57.5%)	16 (21.9 %)	73

Notes: MCD: minimal change disease; FSGS: focal segmental glomerulosclerosis; DMP: diffuse mesengial proliferation; SSNS: steroid sensitive nephrotic syndrome; SRNS: steroid resistent nephrotic syndrome; SDNS: steroid dependent nephrotic syndrome; FR: frequently relapsing.

Table 4. Clinical findings and prognosis according to gender.

	Female	Male	p
Hematuria	35.9%	21.6 %	0.001
Hypertension	10.9%	11.9%	0.894
Biopsy findings	26 patients	47 patients
FSGS	57.7%	57.4%	0.86
DMP	23.0%	21.3%
MCD	19.3%	21.3%
Response to steroids	148 patients	224 patients
Sensitive	77.7%	82.2%
Resistant	22.3%	17.8%	0.544
Dependent	2.0%	3.6%
Frequently relapsing	2.0%	3.6%
Presence of at least one relapse	50.6%	59.8%	0.68

Table 5. Clinical findings and prognosis according to age groups.

	Patients five years old and below (n = 272)	Patients above five years old (n = 120)	p
Hematuria	27.2%	27.5%	0.951
Hypertension	9.9%	15%	0.204
Renal biopsy findings	38 patients	35 patients
FSGS	55.2%	60.0%	0.623
DMP	26.4%	17.1%
MCD	18.4%	22.9%
Response to steroids	258 patients	114 patients
Sensitive	84.4%	71.0%
Resistant	15.5%	29.0%	0.005
Dependent	3.1%	2.6%
Frequently relapsing	3.9%	0.9%	0.022
Relapse rate (at least once)	63.1%	40.3%	0.001

Figure 3. Frequency of relapses according to years.

Table 6. Prognosis according to response to steroids.

Prognosis	Total number	SSNS number (%)	SRNS number (%)	SDNS/FR number (%)	LSR number (%)
Complete remission	321^a	255 (96.7%)	34 (46.6%)	20 (91%)	12 (80%)
Partially remission	8	0	8 (11%)	0	0
CKD	8	0	8 (11%)	0	0
ESRD	4	0	3 (4.1%)	0	1 (6.7%)
Exitus	3	1 (0.4%)	2 (2.7%)	0	0
Lost to follow up	28^b	6 (2.9%)	18 (24.6%)	2 (9%)	2 (13.3%)
Total	372^a,b	262	73	22	15

Notes: SSNS: steroid sensitive nephrotic syndrome; SRNS: initially steroid resistant nephrotic syndrome; SDNS/FR: steroid dependent and/or frequently relapsing nephrtoic syndrome; LSR: nephrotic syndrome with late steroid resistence; CKD: chronic kidney disease; ESRD: end stage renal disease.

^aSix patients entered remission spontaneously.

^bFourteen patients lost to follow-up before evaluating their response to steroids.