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PROGNOSIS IN THE NEPHROTIC SYNDROME A STUDY BASED ON RENAL BIOPSY FINDINGS
Author(s) -
Horvath J. S.,
Johnson J. R.,
Horvath D. G.
Publication year - 1971
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1971.tb50530.x
Subject(s) - nephrotic syndrome , renal biopsy , medicine , biopsy , pathology , intensive care medicine
One hundred and sixty patients with the nephrotic syndrome seen at Royal Prince Alfred Hospital during the decade 1959 to 1969 have been reviewed. Sixteen per cent had the nephrotic syndrome associated with a specific disease entity such as diabetes mellitus. Eighty‐four per cent were regarded as suffering from the idiopathic nephrotic syndrome. The histological findings in the idiopathic group are described. There were no historical, clinical or biochemical findings which were in any way reliable in predicting the subsequent biopsy findings in the idiopathic nephrotic syndrome. Renal biopsy was essential for the accurate diagnosis of the syndrome in any individual case. Patients with the “minimal lesion” had the most favourable shortterm and long‐term prognosis. The value of corticosteroid therapy in this group was confirmed; but, despite this, some patients progressed to renal failure by the development of focal sclerosing glomerulonephritis. Membranoproliferative glomerulonephritis had the worst overall prognosis. Two patients whose Initial biopsies respectively showed acute diffuse proliferative glomerulonephritis and subsiding acute diffuse proliferative glomerulonephritis progressed to renal insufficiency by the development of histologically demonstrable membranoproliferative glomerulonephritis. Diffuse membranous glomerulonephritis was only slowly progressive and failed to respond to any therapeutic régime employed. Focal sclerosing glomerulonephritis was variably progressive, and patients failed to respond to any therapy, with the exception of one patient in whom remission was achieved with corticosteroids. Focal proliferative glomerulonephritis did not appear to respond to corticosteroids, and most patients developed progressive renal insufficiency (the exception being two patients who had associated rheumatoid arthritis). The one patient with focal necrotizing glomerulonephritis followed a rapidly progressive course, without response to prednisone and azathioprine.