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Complete Remission in the Nephrotic Syndrome Study Network.

Publication ,  Journal Article
Gipson, DS; Troost, JP; Lafayette, RA; Hladunewich, MA; Trachtman, H; Gadegbeku, CA; Sedor, JR; Holzman, LB; Moxey-Mims, MM; Perumal, K ...
Published in: Clin J Am Soc Nephrol
January 7, 2016

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.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

January 7, 2016

Volume

11

Issue

1

Start / End Page

81 / 89

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Remission Induction
  • Proteinuria
  • Prospective Studies
  • Proportional Hazards Models
  • Outcome Assessment, Health Care
  • Nephrotic Syndrome
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
 

Citation

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Gipson, D. S., Troost, J. P., Lafayette, R. A., Hladunewich, M. A., Trachtman, H., Gadegbeku, C. A., … Kretzler, M. (2016). Complete Remission in the Nephrotic Syndrome Study Network. Clin J Am Soc Nephrol, 11(1), 81–89. https://doi.org/10.2215/CJN.02560315
Gipson, Debbie S., Jonathan P. Troost, Richard A. Lafayette, Michelle A. Hladunewich, Howard Trachtman, Crystal A. Gadegbeku, John R. Sedor, et al. “Complete Remission in the Nephrotic Syndrome Study Network.Clin J Am Soc Nephrol 11, no. 1 (January 7, 2016): 81–89. https://doi.org/10.2215/CJN.02560315.
Gipson DS, Troost JP, Lafayette RA, Hladunewich MA, Trachtman H, Gadegbeku CA, et al. Complete Remission in the Nephrotic Syndrome Study Network. Clin J Am Soc Nephrol. 2016 Jan 7;11(1):81–9.
Gipson, Debbie S., et al. “Complete Remission in the Nephrotic Syndrome Study Network.Clin J Am Soc Nephrol, vol. 11, no. 1, Jan. 2016, pp. 81–89. Pubmed, doi:10.2215/CJN.02560315.
Gipson DS, Troost JP, Lafayette RA, Hladunewich MA, Trachtman H, Gadegbeku CA, Sedor JR, Holzman LB, Moxey-Mims MM, Perumal K, Kaskel FJ, Nelson PJ, Tuttle KR, Bagnasco SM, Hogan MC, Dell KM, Appel GB, Lieske JC, Ilori TO, Sethna CB, Fervenza FC, Hogan SL, Nachman PH, Rosenberg AZ, Greenbaum LA, Meyers KEC, Hewitt SM, Choi MJ, Kopp JB, Zhdanova O, Hodgin JB, Johnstone DB, Adler SG, Avila-Casado C, Neu AM, Hingorani SR, Lemley KV, Nast CC, Brady TM, Barisoni-Thomas L, Fornoni A, Jennette JC, Cattran DC, Palmer MB, Gibson KL, Reich HN, Mokrzycki MH, Sambandam KK, Zilleruelo GE, Licht C, Sampson MG, Song P, Mariani LH, Kretzler M. Complete Remission in the Nephrotic Syndrome Study Network. Clin J Am Soc Nephrol. 2016 Jan 7;11(1):81–89.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

January 7, 2016

Volume

11

Issue

1

Start / End Page

81 / 89

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Remission Induction
  • Proteinuria
  • Prospective Studies
  • Proportional Hazards Models
  • Outcome Assessment, Health Care
  • Nephrotic Syndrome
  • Middle Aged
  • Male
  • Kidney Failure, Chronic