THE INFLUENCE OF HORMONE TREATMENT ON THE NATURAL EVOLUTION OF THE IDIOPATHIC NEPHROTIC SYNDROME IN CHILDHOOD

Summary In 43 children with idiopathic nephrotic syndrome (INS) who were treated with ACTH or corticosteroids, the evolution was studied after 4 to 14 ½ years. Frequent control investigations revealed that 29 patients were probably cured, 3 were dead, 2 showed a late recurrence and in 1 sequelae were found. In 7 patients, the NS was characterized by the occurrence of multiple relapses. The comparison of these data with those of a prior identical follow-up study in 44 patients of the pre-hormonal era, permitted a gross evaluation of the influence of hormone therapy on the natural course of the INS. It was demonstrated that more hormonally treated patients cured, but that, due to the more frequent occurrence of relapses, definitive healing was significantly postponed. Less patients died, the number of late relapses and sequelae was not very different in both groups. Multiple relapses were seen only in the hormonal group. The cured patients and those with multiple relapses thus probably represent the patients who would have died in the pre-hormonal era, but it is not known which effect is due to antibiotics and hormones respectively. The long-term effect of hormone therapy will depend on the evolution in this group with multiple relapses. The histologic lesions in the kidney, found in some of these patients suggest that probably in a part of them, a fatal issue is to be expected. Further follow-up studies in the other patients with multiple relapses but with shorter follow-up periods, will reveal if identical lesions occur later in all these patients. If this is the case, the long-term effect of hormone therapy in our patients consisted in an important postponement of the fatal issue.