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Age and prediction of remission and relapse of proteinuria and corticosteroid-related adverse events in adult-onset minimal-change disease: a retrospective cohort study.

AbstractBACKGROUND:
In adult-onset minimal-change disease (MCD) the predictors of remission and relapse of proteinuria and corticosteroid-related adverse events remain unknown.
METHODS:
The multicenter retrospective cohort study, the STudy of Outcomes and Practice patterns of Minimal-Change Disease (STOP-MCD), included 142 adult-onset MCD patients in 5 nephrology centers in Japan. Primary outcomes were first remission of proteinuria defined by urinary protein (UP) <0.3 g/day, UP/creatinine ratio (UPCR) <0.3, and/or negative/trace by dipstick test and first relapse of proteinuria defined by UP ≥1.0 g/day, UPCR ≥1.0, and/or dipstick test ≥1+ followed by immunosuppressive therapy. Secondary outcomes were corticosteroid-related adverse events.
RESULTS:
During the median 3.6 (interquartile range, 2.0-6.9) years of the entire observational period, 136 (95.8 %) and 79 (58.1 %) patients developed at least 1 remission and 1 recurrence within a median of 15 (10-34) days and 0.90 (0.55-1.57) years, respectively. Compared with younger patients aged 15-29 years at kidney biopsy, elderly patients aged ≥60 years developed remission significantly later [hazard ratio 0.53 (95 % confidence interval 0.32-0.88)], while older patients aged ≥45 years were at a significantly lower risk of relapse [45-59 years, 0.46 (0.22-0.96); 60-83 years, 0.39 (0.21-0.74)]. However, older patients were significantly more vulnerable to severe infection, diabetes, and cataract as compared with younger patients.
CONCLUSION:
Younger patients had a higher risk of relapse while older patients had a lower risk of relapse but a higher risk of corticosteroid-related adverse events.
AuthorsMaki Shinzawa, Ryohei Yamamoto, Yasuyuki Nagasawa, Susumu Oseto, Daisuke Mori, Kodo Tomida, Terumasa Hayashi, Masaaki Izumi, Megumu Fukunaga, Atsushi Yamauchi, Yoshiharu Tsubakihara, Hiromi Rakugi, Yoshitaka Isaka
JournalClinical and experimental nephrology (Clin Exp Nephrol) Vol. 17 Issue 6 Pg. 839-47 (Dec 2013) ISSN: 1437-7799 [Electronic] Japan
PMID23512647 (Publication Type: Journal Article, Multicenter Study)
Chemical References
  • Glucocorticoids
Topics
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Female
  • Glucocorticoids (adverse effects)
  • Humans
  • Male
  • Middle Aged
  • Nephrosis, Lipoid (drug therapy)
  • Proteinuria (drug therapy)
  • Recurrence
  • Remission Induction
  • Retrospective Studies

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