Nephrotic Syndrome in Japan and Other Asian Countries — Epidemiology and Treatment

Abstract

Nephrotic syndrome (NS) is a common form of childhood renal disease in Asian, as well as in Western, countries. According to the multicenter clinical study on the epidemiology of NS in Japan [1,2], approximately 9000 children with renal disease were seen as in- or out-patients over the two-year period between 1984 and 1985. Of these patients, 14% had NS. Steroids were first used to treat the patients with primary NS, and 90% of the patients responded well, but subsequent relapse during steroid therapy, or shortly after stopping the therapy, was noticed in 33% of the patients. Proteinuria persisted in 9%. Renal biopsy was done on a quarter of the patients who showed good response to steroids, including frequently relapsing patients, and on 80% of the children who showed poor response to, or resistance to, steroids. Under these circumstances, minor abnormalities and diffuse mesangial proliferation were often seen in patients who responded well to steroids. Patients who responded poorly to steroids or were resistant to steroid therapy were prone to show diffuse mesangial prolification, focal segmental sclerosis, and membranoproliferative glomerulonephritis. Approximately 10% of the patients in this group had minor lesions. The majority of primary NS patients in Korea (Dr. KW Ko, Seoul, 1990, personal communication) and in China (Dr. P. Wang, Beijing, 1990, personal communication) had minimal change disease and proliferative glomerulonephritis. Focal segmental sclerosis was diagnosed in a significant number of Korean patients.