This Kidney International review summarises long-term outcomes of childhood idiopathic nephrotic syndrome. Response to steroids remains the strongest prognostic factor.
About half of children with steroid-sensitive disease have frequent relapses or steroid dependence, and around a quarter relapse at least once in adulthood — more often if they needed second-line immunosuppression. Fewer than 10% become steroid-resistant later. Kidney failure and death are uncommon in steroid-sensitive disease. Steroid-resistant disease carries far more complications: growth impairment, obesity, hypertension, osteoporosis, cataracts, calcineurin inhibitor nephrotoxicity and progressive CKD. Up to a third of steroid-resistant cases are monogenic, and monogenic or multidrug-resistant disease carries a three- to fourfold higher risk of kidney failure.
The practical implications are about transition: adult nephrologists will see relapses in patients told they would 'grow out of it', and genetic testing in steroid resistance guides both prognosis and avoidance of futile immunosuppression.
- Warn families that steroid-sensitive nephrotic syndrome can relapse in adulthood.
- Offer genetic testing in steroid-resistant disease — up to a third are monogenic.
- Monitor for steroid toxicity: growth, bone density, cataracts, blood pressure.
- Plan structured transition to adult nephrology services.
Why it matters
It corrects the expectation that steroid-sensitive disease reliably ends at puberty.
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