The nephrotic syndrome, characterized by, profuse roteinuria, hypoproteinemia and generalized edema, may occur during
the courses of various primary renal diseases and is also observed in systemic diseases involving the kidney. Although the nephrotic syndrome due to primary, renal disease often appears as part of the natural course of glomerulonephritis, a significant number of patients without clinical evidence of glomerulonephritis may resent a nephrotic syndrome of unknown etiology, which is designated as idiopathic nephrotic syndrome. However, most workers now agree that the profuse roteinuria in idiopathic nephrotic syndrome is a consequence of a. primary glomerular lesion, which is characterized by extensive fusion of the epithelial root processes or a marked thickening of the glomerular capillary basement membrane. Clinically, the manifestation and natural course of idiopathic nephrotic syndrome are variable, the response to steroid therapy is unpredictable, and a question that remains to be answered is whether the nephrotic syndrome due to primary glomerular disease represents different diseases or different stages of one disease.
Clinical observations were done on thirty-nine cases of idiopathic nephrotic syndrome in adults admitted to the Daegu Fatima Hospital during the six-year period from July 1967 to June 1973 and following results were obtained.
1. The morbidity to idiopathic nephrotic syndrome in adults was much higher in the male, the male to female ratio being approximately 3:1. The patients ranged in age from fifteen to sixty-seven years and the highest age incidence was in the third decade.
2. The maximum daily protein excretion prior to institution of steroid therapy was 3 to 4 gm. in 21 per cent of the cases, 5 to 10 gm. in 67 per cent and 11 gm. or more in 13 per cent.
3. Serum albumin was 1.0 gm. or less per 100 ml in 21 per cent of the cases, 1.1 to 2.0 gm. per 100 ml. in 59 per cent and 2.1 to 2.8 gm per 100ml in 21 per cent.
4. Serum cholesterol was 300 mg or less per 100 ml in 26 per cent of the cases, 301 to 500 mg. in 41 per cent and 501 to 1, 000 mg. per 101 ml. in 33 per cent.
5. Five patients (13 per cent) had blood urea nitrogen of 41 to 60 mg per 100 ml. Twenty-three patients (59 per cent) had 3 to 20 red blood cells per high power field. Seven patients (18 per cent) had systolic blood pressure of 150 to 170 mmHg and eight patients (21 per cent) had diastolic blood pressure of 90 to 110 mmHg.
6. The response of thirty-nine adult patients treated with steroids showed complete remission 38 per cent of the cases, steroid dependent remission in 10 per cent, partial remission in 31 percent and no effect in 21 per cent.
7. A mild elevation of blood urea nitrogen and blood pressure, and microscopic hematuria did not necessarily preclude a good response to steroid therapy.
8. There was no demonstrable relationship between the response to steroids and the duration of illness between onset of disease and start of therapy.
9.There was a significant relationship between the response to steroids and the serum cholesterol level prior to therapy. Thus, of twenty-nine patients having serum cholesterol of 301 mg. or more per 100 ml., eighteen had complete remission or steroid dependent remission, whereas of ten patients having serum cholesterol of 300 mg. or less per 100 ml., only one had complete remission.
10. The complications of steroid therapy were seen in 18 per cent of the cases and these were anxiety, hypertension, pulmonary tuberculosis and duodenal ulcer. These complications occurred mainly in patients who received a prolonged daily course of steroid therapy.
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