Prognosis

Death in the developed world is rare but well documented, and mainly occurs from infectious and thrombotic complications.[4][5][37]​ In the developing world, despite the limited therapeutic facilities, half of nephrotic syndrome (NS) patients benefit from corticosteroids, but corticosteroid resistance has been shown to result in high mortality.[38] Lack of resources, late referrals, and the high cost of kidney replacement therapy in these countries leads to poor outcome in chronic kidney disease due to all causes, including NS and minimal change disease (MCD).[38]

Remission of proteinuria after corticosteroid therapy has greater prognostic value than the precise kidney histology in relation to long-term outcome.

Transition to adulthood

Most children outgrow MCD and stop having relapses in their teenage years although more than 10% of childhood-onset corticosteroid-sensitive NS patients still experience relapses during adulthood.[2]​ However, kidney function can be normal and overall morbidity low.[39] Corticosteroid-resistant NS has a poor kidney outcome, with 34% to 64% progressing to end-stage renal disease (ESRD) within 10 years of diagnosis.[40]​ Transition to an adult nephrologist is recommended for all children approaching adulthood.

Even in adults, MCD has a favourable prognosis with over 80% of patients achieving remission with corticosteroids for the initial episode.[3]​​ However, as seen in children, the majority of the adults who go into remission will relapse, requiring long-term immunosuppression, with significant morbidity because of side effects.[1] A minority of adults with MCD eventually develop focal segmental glomerulosclerosis, which can lead to eventual kidney failure.[1][3]​​ In addition, adults with MCD tend to respond more slowly, with more than 25% of responders taking 3-4 months or longer to undergo complete remission.[25]

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