THE USE OF STEROIDS IN THE TREATMENT OF THE NEPHROTIC SYNDROME IN ADULTS

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Abstract
Twenty-six adult patients suffering from the nephrotic syndrome have been treated with steroids and followed up for periods of up to 5 years. Steroid therapy was given to these patients only if proteinuria persisted after they had been rendered free from edema by diuretics, aldosterone antagonists, or cation-exchange resins. Four patients responded by complete loss of proteinuria; in 7 patients proteinuria responded by a decrease to less than 1.0 g per liter. Fifteen patients failed to respond. Absence of red cells in the spun deposit was a finding of prognostic importance. A good response could be obtained in patients with a raised blood urea level or with hypertension. Percutaneous renal biopsy was performed on 14 patients. The appearance of focal intercapillary hyalin deposition was the earliest change noted in the sections. Patients whose renal lesion was confined to this change tended to respond well to treatment with steroids. In general the more developed the thickening in the basement membrane of the glomerular tufts the less often was a good therapeutic response obtained. No clear-cut correlation was obtained, however, between the histological appearance of the kidney and the response to treatment.

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