Long-term outlook for children with nephrosis
Although the kidneys of children with nephrosis leak large amounts of protein, the protein spillage is usually a short-term problem and does not permanently damage the kidney. The important function of the kidneys (to clear waste products from the blood and excrete them in the urine) remains normal in most children. For this reason, such children do not show the signs of chronic kidney failure (sometimes referred to as uremia), which can be seen in other kinds of kidney disease.
Recurrences/relapses
Although a small number of children may have only one bout of illness with permanent recovery thereafter, most children have recurrences over the years. Therefore, this condition is said to have a chronic, relapsing course. However, the tendency to have relapses is most frequent during the first 3 to 5 years after onset of the illness and usually becomes less frequent thereafter.
After 5 years, the majority of children, up to 75%, do not have more relapses and are considered healthy. However, the remaining 25% of children with nephrosis may have relapses for as long as 10 to 15 years after onset of the illness. We cannot predict which child will have a long-lasting remission or when it will occur. The length of a remission between relapses is variable; as short as a few months or as long as a few years. An occasional child with a relapsing course over many years may become less responsive to treatment.
Although there may be a good initial response to treatment using prednisone, with complete disappearance of protein from the urine (remission), this does not mean that the child is permanently healed. As a matter of fact, the tendency for a recurrence of the protein leakage and swelling is relatively high. Sometimes a remission does not last very long; a relapse may occur within a few months. Some children may have as many as 2 to 4 in a year. In such instances, the side effects of prednisone treatment become much more prominent, and the physician and parents must then give further consideration to other medications.
Treatment of a relapse does not always require admission to the hospital. A child with frequent, closely-spaced relapses may not have a prolonged period off of prednisone. Such “steroid-dependent” children are especially prone to the side effects of treatment. Long-term studies suggest that the tendency to have recurrences of nephrosis may lessen after adolescence.
Will my child's later life be normal? Will my daughter be able to have children?
The answer to both questions is yes. As mentioned above, this disease becomes much less of a problem as the child gets older; by the age of 18 years, it is permanently resolved in practically all individuals. It usually does not leave any serious long-term after effects. Nephrosis or treatment with prednisone does not prevent a woman from having children. There is no evidence that pregnancy triggers a relapse. If a relapse does occur during pregnancy, decisions regarding types of medications used and their possible effects on the unborn child should be discussed with the physician and decided on an individual basis.
The outlook for children who are prednisone resistant
It is difficult to predict the outlook for the small number (around 10%) of children who do not respond to prednisone or who initally responded but later became "resistant" to prednisone. So it is necessary that the child have regular, periodic check-ups by the physician. Some patients may have relapses for many years without any obvious damage or scarring in the kidneys.
Other children have a gradual and spontaneous clearing of the protein leak. Unfortunately, some children have a persistent leak of protein in the urine, and over a period of time — perhaps several years — a gradual scarring process may occur in the kidneys . The functioning tissue of the kidney is slowly replaced by scar tissue, and the symptoms of chronic kidney failure may develop. In some children with steroid-resistant nephrotic syndrome, a biopsy may show a more severe disease, called FSGS. With the availability of dialysis and kidney transplantation, your child can be offered these treatments for kidney failure.