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Analysis of Major Predictive Factors After Ten-Year Follow-up

Beldon A. Idelson, MD; Neil Smithline, MD; Gordon W. Smith, MD; John T. Harrington, MD

Arch Intern Med. 1977;137(7):891-896.

Abstract
This long-term study analyzes the prognostic value of the quantitative urinary protein excretion during and following steroid administration, the renal functional status three years after the onset of disease, and the degree of histologic-damage in adult patients with steroidtreated idiopathic nephrotic syndrome (INS).

No patient who had a complete (proteinuria < 0.1 gm/day) or partial (proteinuria < 2.0 gm/day) remission during steroid administration progressed to renal failure. Furthermore, no patient in whom urinary protein excretion subsequently fell to below 2.0 gm/day ever progressed to renal failure. Only 3 of 49 patients in whom renal function was normal three years after the onset of INS developed renal failure. Finally, renal failure occurred in only 2 of 28 patients with mild abnormalities by light microscopy, compared with 12 of 21 patients with more advanced glomerular abnormalities.

Thus, a partial, as well as a complete remission during steroid administration, subsequent reduction in proteinuria to below 2 gm/day, persistence of normal renal function beyond three years, or the presence of mild histologic abnormalities auger a favorable long-term prognosis in patients with INS.

(Arch Intern Med 137:891-896, 1977)

Author Affiliations
From the Renal Divisions, Boston University School of Medicine (Evans Memorial University Hospital) (Drs Idelson and Smith) and Tufts University School of Medicine, New England Medical Center Hospital (Drs Smithline and Harrington), Boston.

Footnotes
Accepted for publication Aug 3, 1976.

Reprint requests to Clinical Renal Unit, University Hospital, 75 E Newton St. Boston, MA 02118 (Dr Idelson).

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