Prognosis Most children with steroid-responsive nephrotic syndrome have repeated relapses, which generally decrease in frequency as the child grows older. Although there is no proven way to predict an individual childs course, children who respond rapidly to steroids and those who have no relapses during the first 6 mo after diagnosis are likely to follow an infrequently relapsing course. It is important to indicate to the family that the child with steroid-responsive nephrotic syndrome is unlikely to develop chronic kidney disease, that the disease is rarely hereditary, and that the child (in the absence of prolonged cyclophosphamide therapy) will remain fertile. To minimize the psychologic effects of the condition and its therapy, children with idiopathic nephritic syndrome should not be considered chronically ill and should participate in all age-appropriate childhood activities and maintain an unrestricted diet when in remission. Children with steroid-resistant nephrotic syndrome, most often caused by FSGS, generally have a much poorer prognosis. These children develop progressive renal insufficiency, ultimately leading to end-stage renal disease requiring dialysis or kidney transplantation. Recurrent nephrotic syndrome develops in 30-50% of transplant recipients with FSGS. There have not been adequate randomized clinical trials in this subset of patients to guide therapy. A large NIH sponsored multicenter, randomized clinical trial is comparing cyclosporine with mycophenolate mofetil in the treatment of focal segmental glomerulosclerosis admin nasi
Posted on: Sun, 13 Jul 2014 11:19:43 +0000
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