Long-term Follow-up of Adult-onset Minimal Change Nephrotic Syndrome / 대한신장학회잡지

BACKGROUND: Adult-onset minimal change nephrotic syndrome has been associated with a good response to corticosteroids and a benign prognosis. However, there are few longterm outcome data reported. METHODS: A series of 355 patients with adult-onset minimal change nephrotic syndrome (MCNS) who were admitted to Keimyung University Dongsan Medical Center from December 1978 to May 2002, was retrospectively analyzed to evaluate the initial response to corticosteroids, subsequent response to cytotoxic agents, the stability of remission, and long-term follow-up outcome. RESULTS: Of the 145 patients who followed up greater than two years, 69 patients (47.6%) showed early relapse, late relapser in 54 patients (37.2%), and no relapse in 22 patients (15.2%). Early relapsers showed younger age at onset, more frequent relapse, and longer duration of total corticosteroid treatment and shorter duration of corticosteroid used duration at relapse. Alkylating agents or cyclosporine were administered to 45 patients (19 steroid dependent, 13 frequent relapses, 8 steroid side effect, 2 infrequent relapses, 3 steroid resistant), 36 patients achieved complete remission, five in partial remission, and four in no response at all. Among 29 patients who were treated with cyclosporine, 23 patients showed complete remission, 4 achieved partial remission, and 2 showed no response. Final outcome of 145 patients who were followed for at least more than 2 years, were cyclosporine A dependent in 19 (13.2%) patients. steroid dependent in 16 (11.0%), persistent remission in 57 (39.3%), infrequent relapse in 49 (33.8%), death 2 (1.3%), renal failure 1 (0.7%), and no response to any therapy in 1 (0.7%). CONCLUSION: Adult-onset minimal change nephrotic syndrome shows favorable response to corticosteroid therapy with good long-term outcome and rarely progress to end-stage renal failure. However, new treatment regimens to minimize drug-related side effects and to maintain longer remission period should be evaluated prospectively.

Post-Biopsy Arterio-Venous Fistula: Color Doppler Sonography in Evaluation of Its Incidence and Evolution / 대한신장학회잡지

Arteriovenous fistulae(AVF) are well documented complications of percutaneous renal biopsy. Between August 1995 and April 1997, we prospectively studied 280 consecutive ultransound-guided percutaneous renal biopsies to evaluate the incidence of post-biopsy AVF and its natural course. All biopsies patients were monitored through a routine follow-up echo-color popple sonography at post-biopsy 1, 7, 14 and 30 days. The 28 patients(10%) out of 280 consecutive percutaneous renal biopses were diagnosed to have AVF. There was no differences in the incidence of AVF between native and transplanted kidney biopsy. Most AVF were small(<2cm) and caused minimal or no symptoms. AVF was accompanied with large hematoma(thickness above 2cm) was observed in 9 cases(53%) of 17 native kidneys and none in 10 transplanted kidneys. This difference was statistically significant(P=0.008). At follow-up, AVF resolved spontaneously in 24 cases(87%). In two patients(7.1%) required superselective arterial embolization, one develoved spontaneous rupture of AVF, and one had persistence of AVF over 12 months. We concluded that color Doppler sonography provides a good, non-invasive and safe method for diagnosis and follow up of post-biopsy AVF.