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Original ArticleOpen Access
Long-term Follow-up Study of lgM Associated Nephrotic Syndrome Patients : Clinical Outcome and Prognostic Indicators
Kuratlzong P 
,
Jesdapatarakul S
,
Jesdapatarakul S PATHRA KURATHONG,M.D.*,
SOMNUEK JESDAPATARAKUL, M.D.**
Rationale
: Even though it is the most common primary glomerular disease, the natural
history and prognosis of lgM associated nephrotic syndrome have not been well established.
Objectives
: To determine the
(1)
responsiveness to prednisolone therapy, (2) long-term
clinical and laboratory outcomes, and (3) prognostic indicators to prednisolone therapy in patients
with IgM associated nephrotic syndrome.
Study design
: Clinical descriptive, longitudinal study.
Subjects
: Seventy two biopsy-proved IgM associated nephrotic syndrome patients,
diagnosed between 1978-1996 at Vajira Hospital, Bangkok, were included in the study.
Method
: Clinical parameters with age, sex, duration of edema, blood pressure and labo-
ratory findings such as hematuria, BUN, creatinine, albumin, and cholesterol, 24-hour urine protein,
and stool examination, were collected pre-renal biopsy. Each patient was treated with 45-60 mg of
prednisolone according to body weight, for up to 8 weeks. Each patient was followed-up every
4-weeks for clinical and laboratory evaluations, and for adjusting the steroid dosage. Clinical
responses were stratified into 3 groups as steroid responsive (SRP), steroid dependent (SD), and
steroid resistant (SRS).
Main outcome measures
: (I) Frequency and types of steroid responsiveness. (2) Inci-
dence of hypertension, hematuria, renal insufficiency, end-stage renal disease, and survival during
the follow-up. (3) Prognostic indicators for initial clinical response to prednisolone, and for
long-term morbidity and mortality.
Results
: Forty eight of the 72 patients (66.67%) were responsive to prednisolone at
8-weeks, the 24 remaining patients (33.33%) were nonresponsive. High proteinuria of 7.66
เธ‘
4.14
g/D was the only good prognostic indicator to initial prednisolone therapy (p < 0.03). During the
follow-up, 42(58.33% ), 26(36.11% ), and 4(5.56%) patients were SRP, SD, and SRS, respectively.
There were no prognostic indicators associated with long-term steroid responsiveness. Of the 60
patients followed-up for more than one year; 34, 15 and 11 patients were followed-up for 1-5,
*
Department of Medicine,
**
Department of Pathology, Bangkok Metropolitan Administration Medical College, and Vajira Hospital, Bangkok
1 0300, Thailand.
316
SOMNUEK JESDAPATARAKUL, M.D.**
Rationale
: Even though it is the most common primary glomerular disease, the natural
history and prognosis of lgM associated nephrotic syndrome have not been well established.
Objectives
: To determine the
(1)
responsiveness to prednisolone therapy, (2) long-term
clinical and laboratory outcomes, and (3) prognostic indicators to prednisolone therapy in patients
with IgM associated nephrotic syndrome.
Study design
: Clinical descriptive, longitudinal study.
Subjects
: Seventy two biopsy-proved IgM associated nephrotic syndrome patients,
diagnosed between 1978-1996 at Vajira Hospital, Bangkok, were included in the study.
Method
: Clinical parameters with age, sex, duration of edema, blood pressure and labo-
ratory findings such as hematuria, BUN, creatinine, albumin, and cholesterol, 24-hour urine protein,
and stool examination, were collected pre-renal biopsy. Each patient was treated with 45-60 mg of
prednisolone according to body weight, for up to 8 weeks. Each patient was followed-up every
4-weeks for clinical and laboratory evaluations, and for adjusting the steroid dosage. Clinical
responses were stratified into 3 groups as steroid responsive (SRP), steroid dependent (SD), and
steroid resistant (SRS).
Main outcome measures
: (I) Frequency and types of steroid responsiveness. (2) Inci-
dence of hypertension, hematuria, renal insufficiency, end-stage renal disease, and survival during
the follow-up. (3) Prognostic indicators for initial clinical response to prednisolone, and for
long-term morbidity and mortality.
Results
: Forty eight of the 72 patients (66.67%) were responsive to prednisolone at
8-weeks, the 24 remaining patients (33.33%) were nonresponsive. High proteinuria of 7.66
เธ‘
4.14
g/D was the only good prognostic indicator to initial prednisolone therapy (p < 0.03). During the
follow-up, 42(58.33% ), 26(36.11% ), and 4(5.56%) patients were SRP, SD, and SRS, respectively.
There were no prognostic indicators associated with long-term steroid responsiveness. Of the 60
patients followed-up for more than one year; 34, 15 and 11 patients were followed-up for 1-5,
*
Department of Medicine,
**
Department of Pathology, Bangkok Metropolitan Administration Medical College, and Vajira Hospital, Bangkok
1 0300, Thailand.
316
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