Adrenal Steroids in the Treatment of Idiopathic Nephrotic Syndrome in Adults

Abstract

An attempt was made to assess the impact of adrenal steroids on the natural history of idiopathic nephrotic syndrome (INS) in adults and to compare the results with what little is known about the course of the untreated disease. Forty-two adults with INS, whose renal function was normal, or nearly so, were treated with large doses of adrenal steroids for periods ranging from one to many months. The major observations were: Seven patients (17%) promptly lost their proteinuria (protein excretion<100 mg/day) and all other stigmata of renal disease. Six others (14%) showed no apparent response to treatment but subsequently, at intervals ranging from 3 months to 7 years, underwent complete remission. Adequate renal biopsies were obtained before treatment in 20 patients. Five of the 6 who had only minimal hypercellularity of glomeruli ultimately became free of proteinuria; none of the remaining 14 who had more severe histologic changes underwent remission. Prognosis could be correlated with any other clinical or laboratory findings. Major complications occurred during treatment in 11 patients (26%) and there was one death. Of 12 patients followed for 5 years (10 of whom had persistent proteinuria) 10 were still alive and 9 had no evidence of renal functional impairment, thus giving a 5-year survival rate of 83%. It was pointed out that evaluation of the efficacy of treatment with steroids must rest upon a comparison with the natural history of the untreated disease. Limited data on the literature indicate that approximately one-fifth of untreated patients ultimately undergo remission, whereas in the present treated series the total remission rate was 31%. An analysis of the data suggests but does not clearly establish - that steroids may not only hasten remission but may also increase the percentage of "cures". It is of interest to note that failure to respond promptly to steroids did not preclude the possibility of later "spontaneous" remission.