Korean Journal of Nephrology 1987;6(1):103-116.

소아 미세변화형 신증후군의 임상적 관찰

김병길 , 이재승 , 양재승 , 최인준

Abstract

The authors reviewed 168 patients with minimal change nephrotic syndrome who were admitted to Sev- erance and Yongdong Severance Hospitals in an 8 year period from July 1978 to June 1986. Responsiveness to intitial steroid therapy was evaluated and the characteristics of relapse were anal- yzed. This study focused on the patients who due to resistance to initial steroid therepay or to frequently occuring relapses were treated with methylprednisolone pulse Therapy and immunosuppressants such as cyclophosphamide or chlorambucil. There were 54 patients (32.1%) with an allergy history among the 168 patients, but there was no significant difference between the initial responder and initial nonresponder groups. The serum IgE level of 105 patients was tested, and 77 patients (73.3%) had an elevated IgE. In th'e initial responder group, 77.8% of the patients had an elevated IgE, and it was significant- ly higher than the initial nonresponder group (46.7%). The initial remission period in the infrequent relap- ser group was 8 months whereas in the "frequent relapser and subsequent nonresponder groups, it was 3 and 2.9 months respectively. We found that the shorter the initial remission period, the more frequent the relpase. Immunosuppressant therapies were administered to 24 patients (9 frequent relapsers, 6 subsequent nonre- sponders and 9 continuing nonresponder). 12 patients achieved complete remission, 6 patients had a period of remission followed by a relapse, and 6 patients demon- strated no response at all. Among 7 patients who received methylprednisolone pulse therapy (3 frequent relapsers, 1 subsequeot nonresponder, 3 continuing nonresponders), 5 patients achieved complete remission, one patient achieved remission but relapsed, and one patient didnt show any response. The mean time required to achieve remission was 50 days in the patients who received the immunosuppres- sant therapy, and 12.3 days in the patients who received the pulse therapy. The difference was statistically significant.