Prognosis

The prognoses for patients with two common causes of the nephrotic syndrome are as follows:

• minimal change disease (MCD):
  • a third have just one episode
  • a third have infrequent relapses
  • a third have frequent relapses throughout childhood which abate during adulthood; life expectancy is normal
    
    
• focal segmental glomerulosclerosis:
  • a third remit after a prolonged course
  • a third have continuing haematuria and proteinuria but have normal renal function
  • a third progress to end stage renal failure

In adults:

• untreated MCD is associated with a risk of mortality due to infection and thromboembolism
• limited data suggest that the rate of spontaneous early remission (eg, within a few months) in adults is approximately 5 to 10 percent
• a substantial proportion of untreated patients eventually undergo remission after a prolonged period
  • only available randomized controlled trial that, in 1970, compared prednisone versus no specific therapy and included 31 patients with MCD
    • remission of proteinuria to less than 1 g/day in the control group occurred in 50 percent by 18 months and approximately 70 percent at three years
    • suuggests that the chief benefit of glucocorticoid is to induce and maintain remission until the poorly understood process responsible for MCD abates.

Reference:

• 1) UptoDate - Treatment of minimal change disease in adults (September 2012)