Complete remission in the nephrotic syndrome study network

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. SethnaFernando 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

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24 Scopus citations

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)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.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number1
DOIs
StatePublished - Jan 7 2016

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ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Gipson, D. S., Troost, J. P., Lafayette, R. A., Hladunewich, M. A., Trachtman, H., Gadegbeku, C. A., Sedor, J. R., Holzman, L. B., Moxey-Mims, M. M., Perumal, K., Kaskel, F. J., Nelson, P. J., Tuttle, K. R., Bagnasco, S. M., Hogan, M. C., Dell, K. M., Appel, G. B., Lieske, J. C., Ilori, T. O., ... Kretzler, M. (2016). Complete remission in the nephrotic syndrome study network. Clinical Journal of the American Society of Nephrology, 11(1), 81-89. https://doi.org/10.2215/CJN.02560315