There is no doubt that the evolution of the idiopathic nephrotic syndrome (INIS) has been thoroughly influenced by ACTH and steroid treatment. The beneficial immediate effect of this treatment is beyond doubt. The long-term effect, however, is still a matter of discussion: the initial optimistic reviews were not always confirmed by subsequent follow-up studies. The aim of the present study was to contribute to the solution of the problem by comparing the evolution in the prehormonal and in the hormonal era in patients with a sufficiently long follow-up period. The results obtained in the pre-hormonal group, comprising 44 patients, were published in 1966 (15).The present paper deals with the results obtained in a similar group from the hormonal period, and also with the results of a comparative study of both groups.
MATERIAL AND METHODSIn this department, hormone treatment of the INS was started in 1952. In order to avoid as much as possible a selection of the material, the first 44 patients with INS admitted since 1952, were studied. This represents an equally large group as was studied in the pre-hormonal period.The criteria on which the diagnosis of INS was based, were the same as for the pre-hormonal group, and were the generally accepted ones: edema, marked proteinuria, hypodysproteinemia and hyperlipemia. Transient hematuria, hypertension or renal insufficiency were considered to be compatible with the diagnosis of INS. Renal biopsies were not yet performed systematically at onset of the disease in this group, and therefore histologic criteria were not taken into consideration. Secondary NS and two patients with congenital NS were excluded from this study .The age-and sex-incidence is represented in Fig. 1. The
-685884average age at onset of the INS was 5 years, with a peak incidence between 2 and 3 years. One child was younger than 12 months, and 4 were older than 10 years. There were 33 boys and 11 girls. From this group of 44 patients one girl who lived abroad, was excluded later from the study as the final control investigation could not be performed. Forthy-three patients were thus left for study.In the course of the years personal experience and literature data have prompted us to adapt our treatment program. Four different periods can be distinguished, as is illustrated by Table 1.The study of the evolution of the INS in these 43 patients is based on the results of frequent investigations during the acute illness, of subsequent control-investigations and of a late re-investigation. The investigations always consisted of a complete clinical examination with repeated measuring of the blood pressure, of a urinalysis and serologic determinations. Mostly, and without exception during the late re-investigation, glomerular function was also measured. In some patients kidney functions were studied more extensively. In some, renal biopsy was also performed during a control investigation. The resulting histologic data were taken into account for evaluation of the present condition of the patient. With the help ...
