HIGH RATE OF MORPHOLOGICAL TRANSITION IN CHILDREN WITH STEROID SENSITIVE MINIMAL CHANGE NEPHROTIC SYNDROME (M.C.N.S.)

Abstract

We reviewed the clinical course and morphology of 48 children with biopsy proven M.C.N.S. with a minimum follow-up of at least 5 years. Mean age at onset was 4.1 yrs (11 mo-16 yrs). Mean follow-up was 11.2 yrs (5-18). 33 of 48 children (66%) underwent a second biopsy at a mean time of 4.5 yrs after the first biopsy because of frequent relapses or steroid dependence. 15 (45%) converted to focal segmental sclerosis (F.S.G.S.). 9 (27%) evolved into IgM nephropathy and only 9 (27%) retained the original morphology of M.C.N.S. 6 of these 9 patients with M.C.N.S. had a 3rd biopsy. Only one showed persistent M.C.N.S., and he converted to IgM nephropathy on 4th biopsy.Overall, among patients undergoing repeat renal biopsies, only 12% continued to show a persistent M.C.N.S. lesion, the rest evolving into IgM nephropathy or F.S.G S. Analysis of age at onset, frequency of hematuria, hypertension or elevated creatinine at onset did not distinguish the children with morphological transition from the remaining ones.At the end of the study, 25% of these children are dead of renal causes, on dialysis, transplanted or in chronic renal failure with a creatinine clearance less than 20 ml/min.Our study concludes that a very high frequency of morphological transition is present in M.C.N.S. patients who have a relapsing or steroid dependent course and that the prognosis ir these cases is guarded.