MINIMAL CHANGE NEPHROTIC SYNDROME IN ADULTS - RESPONSE TO CORTICOSTEROID-THERAPY AND FREQUENCY OF RELAPSE

Rate of response to a corticosteroid and frequency of relapse were studied in 33 patients with adult-onset minimal change nephrotic syndrome (MCNS). Of these, 28 patients were treated with oral prednisolone (PSL) at 1 mg/kg/d for from 4 to 8 weeks depending on their response, followed by PSL, at gradually tapering doses for 1 year. Five severely nephrotic patients received 1 g of methylprednisolone intravenously (IV) for 3 days, followed by 40 mgld oral PSL for 4 to 8 weeks and finally PSL in gradually reduced doses. Sixteen patients (48%) were free of proteinuria within 4 weeks, and 25 (76%) within 8 weeks. Two patients required cyclophosphamide for induction of remission. Age at presentation was not significantly correlated with response time to corticosteroid therapy. Thirty-two (97%) went into remission, and relapse occurred in 11 (34%) of these. As assessed by the life-table method, 84% of patients were still in remission at 6 months after induction of remission, 75% after 1 year, and 63% during the follow-up period (mean, 47.1 ± 29.1 months; range, 6 to 123 months). Incidence of relapse was not correlated with remission induction time, ie, earlier (≤ 4 weeks) or later (> 4 weeks), but was greater in younger (≤ 30 years of age) patients than older (≥ 30 years) patients (P < 0.03). At the last follow-up, 31 patients (94%) were in complete remission and had normal renal function. These results indicate that these Japanese adults with MCNS showed favorable response to corticosteroid therapy with good outcome, and that relapse was less frequent in older patients. © 1991, National Kidney Foundation, Inc.. All rights reserved.