Complete Remission in the Nephrotic Syndrome Study Network.

Abstract

BACKGROUND AND OBJECTIVES:

This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC) <0.3 g/g with preserved native kidney function and (2) ESRD. Continuous variables are reported as median and interquartile range (IQR; 25th, 75th percentile). Cox proportional hazards modeling was used to assess factors associated with CRever.

RESULTS:

We enrolled 441 patients: 116 (27%) had MCD, 142 (32%) had FSGS, 66 (15%) had membranous nephropathy, and 117 (27%) had other glomerulopathy. The baseline UPC was 4.1 g/g (IQR, 1.9, 7.7) and the eGFR was 81 ml/min per 1.73 m(2) (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis.

CONCLUSIONS:

In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.

• Authors: Debbie S Gipson, Jonathan P Troost, Richard A Lafayette, Michelle A Hladunewich, Howard Trachtman, Crystal A Gadegbeku, John R Sedor, Lawrence B Holzman, Marva M Moxey-Mims, Kalyani Perumal, Frederick J Kaskel, Peter J Nelson, Katherine R Tuttle, Serena M Bagnasco, Marie C Hogan, Katherine M Dell, Gerald B Appel, John C Lieske, Titilayo O Ilori, Christine B Sethna, Fernando C Fervenza, Susan L Hogan, Patrick H Nachman, Avi Z Rosenberg, Larry A Greenbaum, Kevin E C Meyers, Stephen M Hewitt, Michael J Choi, Jeffrey B Kopp, Olga Zhdanova, Jeffrey B Hodgin, Duncan B Johnstone, Sharon G Adler, Carmen Avila-Casado, Alicia M Neu, Sangeeta R Hingorani, Kevin V Lemley, Cynthia C Nast, Tammy M Brady, Laura Barisoni-Thomas, Alessia Fornoni, J Charles Jennette, Daniel C Cattran, Matthew B Palmer, Keisha L Gibson, Heather N Reich, Michele H Mokrzycki, Kamalanathan K Sambandam, Gaston E Zilleruelo, Christoph Licht, Matthew G Sampson, Peter Song, Laura H Mariani, Matthias Kretzler
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 11 Issue 1 Pg. 81-9 (Jan 07 2016) ISSN: 1555-905X [Electronic] United States
• PMID: 26656320 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 by the American Society of Nephrology.

Topics

• Adolescent
• Adult
• Biopsy
• Cohort Studies
• Female
• Glomerular Filtration Rate
• Humans
• Kidney (pathology)
• Kidney Failure, Chronic (etiology)
• Male
• Middle Aged
• Nephrotic Syndrome (complications, drug therapy, pathology, physiopathology)
• Outcome Assessment, Health Care
• Proportional Hazards Models
• Prospective Studies
• Proteinuria (physiopathology)
• Remission Induction