This study analyzes the results in sixty-eight patients with the idiopathic nephrotic syndrome treated with adrenal corticoids and followed for a period averaging five and a half years. Approximately one fourth of the patients responded to steroid therapy with a complete remission (i.e., protein excretion less than 100 mg. per day) which, in most cases, was sustained after discontinuation of treatment; four patients, however, remained dependent upon steroid therapy. Beneficial steroid responses occurred only among patients treated within six months of onset of the disease. An additional 14 per cent of patients, whose proteinuria did not disappear during treatment, had a spontaneous remission of their disease at intervals ranging from one to five years after treatment had been discontinued. Thus slightly more than one third of the adults with the idiopathic nephrotic syndrome treated with steroids ultimately became free of proteinuria. Of the group who did not have complete remissions, roughly one-third have either died of uremia or now have significantly impaired renal function after an over-all follow-up of approximately five years. Deterioration of renal function developed only among those who continued to excrete more than 2 gm. of protein per day; the incidence of renal insufficiency in this group was more than 50 per cent. No patient whose protein excretion has fallen to less than 2 gm. per day has so fat shown evidence of significant renal deterioration. The incidence of complications due to treatment was 25 per cent in the group as a whole; however, these complications occurred mainly in patients who received a prolonged daily course of steroid therapy. Inasmuch as intermittent therapy is associated with a low incidence of significant side effects and is seemingly just as effective as continuous therapy, we recommend that patients with idiopathic nephrotic syndrome be treated on an intermittent schedule. Definitive evaluation of the effect of steroids on the natural history of the idiopathic nephrotic syndrome awaits a suitably controlled prospective study. We believe, however, that when the present findings are examined in the light of what is known about the untreated course of the disease, they strongly suggest that steroids have significant beneficial effects. Best results are to be expected when steroid administration is started within six months of the onset of the disease and is reserved for those patients with minimal renal lesions. Our data also suggest that life expectancy may be improved, even in patients who do not have a complete remission, if protein excretion can be reduced to less than 2 gm. per day. © 1969.
