Long-term outcome of biopsy-proven minimal-change nephrotic syndrome in Chinese children

SummaryBackgroundPrevious studies have shown that up to 40% of childhood-onset minimal-change nephropathy (MCN) cases persist after puberty. However, data are scarce concerning the long-term renal prognosis and prevalence of treatment-related complications of this group of patients after they become adults.Materials and methodsThe clinical records of 55 consecutive pediatric patients with biopsy-proven MCN treated in our hospital from 1984 to 2004 were reviewed to evaluate the disease pattern, treatment regimen, and the development of treatment-related complications.ResultsOf the 55 patients treated, 35 were followed after age 18 years; 13 (37%) had relapses during adulthood. Treatment-related complications were observed in 20 patients (57%), including being overweight (23%), impaired fasting glucose (14%), infertility (14%), persistent low grade proteinuria (11%), fracture (9%), and hypertension (9%). All patients had normal renal function when last assessed.ConclusionA substantial proportion of patients with childhood-onset MCN continued to have relapse after they became adults. Although almost all patients have normal renal function, prolonged use of steroid and immunosuppressive agents results in a considerable risk of treatment-related complications. Life-long follow-up seems advisable for this group of patients, not only for detecting relapses, but also to allow timely diagnosis of treatment-related complications.

背景之前的研究顯示，童年病發的微小變化型腎病變(MCN)有高達40%會持續至青春期之後；然而，對於這類病情延續至成年的患者，至今少有研究對其長期腎臟預後及治療相關併發症比率作出報告。方法針對經活檢證實的MCN兒童患者，我們回顧了55位於1984至2004在本院接受治療的連續個案，從而對其病情發展、治療用藥、及治療相關併發症作出瞭解。結果在所有55位兒童病人中，35人持續接受追蹤至成年期。在成年階段中，13人(37%)出現復發，20人(57%)發生治療相關併發症，後者包括過重(23%)、空腹血糖過高(14%)、不孕症(14%)、持續性輕度蛋白尿(11%)、骨折(9%)、及高血壓(9%)。在最後追蹤中，所有人均呈現正常的腎功能。結論不少的童年病發MCN患者會在成年期復發，即使幾乎所有人的腎功能正常，持續使用的類固醇及免疫抑制劑所導致的治療相關併發症風險卻不容忽視。對於這些病人，似乎應予以終生的追蹤，以利於病情復發及治療相關併發症的及早發現。