Adrenal cortical steroid therapy of primary nephrotic syndrome among adult Filipinos: clinical, biochemical and histologic studies

ABSTRACT

An analysis of the response to corticosteroid therapy of 66 patients with primary nephrotic syndrome was presented in this paper. A summary of the clinical status and biochemical data before and after the initial course of corticosteroid therapy is shown in TABLE VIII. Forty three patients followed for 1 to 48 months was likewise analyzed; of these 44 patients, 26 were on intermittent steroids and 18 were not on the drugThe type of response obtained was classified into Grade A, B, C and D. Remission after the initial course was obtained in 62% of the cases treated. In the intermittent-treated group, 58% were in remission at the time of this study in contrast to 41% remission in patients who were not maintained on the drug. There were 15 deaths in this series, 7 occurred in the initial course of treatment and 8 in the follow-up period. All fatalities during the initial course were among uremic patients with endstage kidneys. In the follow-up period deaths were also due to uremia and were on patients who responded poorly do the initial courseCorticosteroids remain the drug of choice in the management of primary nephrotic syndrome and should be used whenever indicated. ACTH therapy is more expensive and requires the parenteral route for its administration. The routine administration of ACTH in the course of corticosteroid therapy was not utilized in this study as this has been shown to be of no value in preventing adrenal insufficiencyKidney biopsies are useful in diagnosis, prognosis and guide to therapy of nephrotic syndrome but should not supersede the clinical features and common laboratory procedures in the choice of patients for corticosteroid therapy as suggested by other authors. Eighteen patients in this study have kidney biopsies. Remissions were obtained in patients with "normal" and minimal degree of glomerular involvement; however; poor results were also seen in patients with minimal changesThe need to follow patients closely and with periodic determination of the common laboratory procedures as a guide to therapy was stressedFinally, corticosteroid therapy of primary nephrotic syndrome is most beneficial in patients ill with the disease for less than 6 months duration, without or with minimal azotemia, hypertension and hematuria, and in cases with "normal" and minimal glomerular changes. Adequate dosage and longer initial course of therapy of at least 6 weeks and possibly more in some cases will insure a higher incidence of remission. The duration of intermittent steroids therapy has not been conclusively settled but it is the general felling that it should be continued for 6 months to 1 year after a successful initial course of treatment in patients who remained in remission. (Summary and Conclusions)