title: Long-term outcome of biopsy-proven minimal change nephropathy in Chinese adults.
abstract: BACKGROUND
  Minimal change nephropathy is a common cause of primary nephrotic syndrome in adults. However, there are few studies of its clinical course, response to treatment, and long-term outcome.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  340 consecutive adult patients with nephrotic syndrome and biopsy-proven minimal change nephropathy treated in a university hospital from 1984 until 2004.
  
  
  METHODS
  Treatment response groups: primary steroid resistance, frequent relapse (≥4 relapses within 1 year), infrequent relapse (≥1 relapse but not frequent relapse), and no relapse (reference group); disease pattern.
  
  
  RESULTS
  Medical problems after diagnosis; patient survival; renal survival.
  
  
  RESULTS
  Median time to remission was 10 (IQR, 8-12) weeks; 179 (52.6%) had no relapse, 42 (12.4%) had infrequent relapses, 86 (25.3%) were frequent relapsers or steroid dependent, and 33 (9.7%) had primary steroid resistance. After a median follow-up of 174.7 (IQR, 119.7-235.0) months, 32 patients developed end-stage renal disease and 62 died (25 after progression to end-stage renal disease). Cox regression analysis showed that age and treatment response groups were the independent predictors of patient survival. Compared to the no-relapse group, the infrequent-relapse group had significantly better patient survival (adjusted HR, 0.19; 95% CI, 0.08-0.44; P<0.001), whereas the primary-steroid-resistance group had significantly worse patient survival (adjusted HR, 5.87; 95% CI, 1.83-18.85; P<0.001). Renal survival was excellent except in the primary-steroid-resistance group.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  A substantial proportion of adult patients with minimal change nephropathy continue to have disease flares more than 10 years after the initial presentation, and medical problems after diagnosis are common.
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Electronic address: ccszeto@cuhk.edu.hk.
authors.forename: Cheuk-Chun
authors.initials: CC
authors.lastname: Szeto
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Fernand Mac-Moune
authors.initials: FM
authors.lastname: Lai
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Chow
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Bonnie Ching-Ha
authors.initials: BC
authors.lastname: Kwan
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Vickie Wai-Ki
authors.initials: VW
authors.lastname: Kwong
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Chi-Bon
authors.initials: CB
authors.lastname: Leung
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009404:Nephrotic Syndrome / Q000150:complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: Minimal change nephropathy (MCN); adult onset; end-stage renal disease (ESRD); glucocorticoid; kidney biopsy; nephrotic syndrome; relapse, disease flare, remission, glomerulonephritis; renal survival; steroid resistant