Longterm Renal Outcome of Idiopathic Nephrotic Syndrome in Children

Objective: To study longterm renal outcome of Thai children with idiopathic nephrotic syndrome (INS). Methods: We retrospectively reviewed 75 INS children followed-up in a tertiary care, university hospital. Male to female ratio was 2:1. Mean age at diagnosis was 6.2 years, and 56.0% were less than 5 years old. 57.3% previously received prednisolone from other hospitals and 32 patients (42.7%) were steroid resistant nephrotic syndrome (SRNS). Initial short stature was found in 1.3%. Hypertension and hematuria was found in 34.7% and 14.7%, respectively. Renal biopsy performed in 40 patients (53.3%) revealed minimal changes disease in 17 (42.5%), focal and segmental glomerulosclerosis (FSGS) in 12 (30.0%), mesangial proliferative glomerulonephritis in 5 (12.5%), IgM nephropathy in 4 (10%), and IgA nephropathy in 2 (5%) patients. Immunosuppressive medications included Cyclophosphamide in 64.5%, Tacrolimus in 14.7%, Cyclosporin in 8.0% and Mycophenolate mofetil in 4.0%. Enalapril was given in 48.0%. Results: Mean follow-up time was 7.4 years. Complete remission was achieved in 77.3%. One patients (1.3%) had Chronic Kidney Disease stage 3 and 5 patients (6.7%) had End Stage Renal Disease (ESRD). One patient with ESRD died of severe respiratory tract infection. The factor associated with poor renal outcome was FSGS (p=0.032). Renal survival at 5,10, and 15 years were 95.3%, 85.7% and 57.2%, respectively. At last follow-up, short stature was found in 4.0% and hypertension in 20.0%. Other complications included cataract (29.3%), glaucoma (9.3%), diabetes mellitus (2.6%), septicemia (9.3%), other infections (10.6%). Conclusion: We suggest that although renal outcome in Thai children may be better than in caucasian, longterm follow up is still needed, especially in children with FSGS.