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Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings.

Publication ,  Journal Article
Pelletier, JH; Kumar, KR; Engen, R; Bensimhon, A; Varner, JD; Rheault, MN; Srivastava, T; Straatmann, C; Silva, C; Davis, TK; Wenderfer, SE ...
Published in: Pediatr Nephrol
October 2018

BACKGROUND AND OBJECTIVES: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence. METHODS: Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence. RESULTS: We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence. CONCLUSIONS: Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.

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Published In

Pediatr Nephrol

DOI

EISSN

1432-198X

Publication Date

October 2018

Volume

33

Issue

10

Start / End Page

1773 / 1780

Location

Germany

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Risk Factors
  • Retrospective Studies
  • Recurrence
  • Prognosis
  • Preoperative Period
  • Nephrotic Syndrome
  • Nephrosis, Lipoid
  • Male
 

Citation

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Pelletier, J. H., Kumar, K. R., Engen, R., Bensimhon, A., Varner, J. D., Rheault, M. N., … Gbadegesin, R. A. (2018). Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. Pediatr Nephrol, 33(10), 1773–1780. https://doi.org/10.1007/s00467-018-3994-3
Pelletier, Jonathan H., Karan R. Kumar, Rachel Engen, Adam Bensimhon, Jennifer D. Varner, Michelle N. Rheault, Tarak Srivastava, et al. “Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings.Pediatr Nephrol 33, no. 10 (October 2018): 1773–80. https://doi.org/10.1007/s00467-018-3994-3.
Pelletier JH, Kumar KR, Engen R, Bensimhon A, Varner JD, Rheault MN, et al. Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. Pediatr Nephrol. 2018 Oct;33(10):1773–80.
Pelletier, Jonathan H., et al. “Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings.Pediatr Nephrol, vol. 33, no. 10, Oct. 2018, pp. 1773–80. Pubmed, doi:10.1007/s00467-018-3994-3.
Pelletier JH, Kumar KR, Engen R, Bensimhon A, Varner JD, Rheault MN, Srivastava T, Straatmann C, Silva C, Davis TK, Wenderfer SE, Gibson K, Selewski D, Barcia J, Weng P, Licht C, Jawa N, Kallash M, Foreman JW, Wigfall DR, Chua AN, Chambers E, Hornik CP, Brewer ED, Nagaraj SK, Greenbaum LA, Gbadegesin RA. Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. Pediatr Nephrol. 2018 Oct;33(10):1773–1780.
Journal cover image

Published In

Pediatr Nephrol

DOI

EISSN

1432-198X

Publication Date

October 2018

Volume

33

Issue

10

Start / End Page

1773 / 1780

Location

Germany

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Risk Factors
  • Retrospective Studies
  • Recurrence
  • Prognosis
  • Preoperative Period
  • Nephrotic Syndrome
  • Nephrosis, Lipoid
  • Male