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Multicenter Study
. 2016 Jan 7;11(1):81-9.
doi: 10.2215/CJN.02560315. Epub 2015 Dec 10.

Complete Remission in the Nephrotic Syndrome Study Network

Debbie S Gipson  1 , Jonathan P Troost  2 , Richard A Lafayette  2 , Michelle A Hladunewich  2 , Howard Trachtman  2 , Crystal A Gadegbeku  2 , John R Sedor  2 , Lawrence B Holzman  2 , Marva M Moxey-Mims  2 , Kalyani Perumal  2 , Frederick J Kaskel  2 , Peter J Nelson  2 , Katherine R Tuttle  2 , Serena M Bagnasco  2 , Marie C Hogan  2 , Katherine M Dell  2 , Gerald B Appel  2 , John C Lieske  2 , Titilayo O Ilori  2 , Christine B Sethna  2 , Fernando C Fervenza  2 , Susan L Hogan  2 , Patrick H Nachman  2 , Avi Z Rosenberg  2 , Larry A Greenbaum  2 , Kevin E C Meyers  2 , Stephen M Hewitt  2 , Michael J Choi  2 , Jeffrey B Kopp  2 , Olga Zhdanova  2 , Jeffrey B Hodgin  2 , Duncan B Johnstone  2 , Sharon G Adler  2 , Carmen Avila-Casado  2 , Alicia M Neu  2 , Sangeeta R Hingorani  2 , Kevin V Lemley  2 , Cynthia C Nast  2 , Tammy M Brady  2 , Laura Barisoni-Thomas  2 , Alessia Fornoni  2 , J Charles Jennette  2 , Daniel C Cattran  2 , Matthew B Palmer  2 , Keisha L Gibson  2 , Heather N Reich  2 , Michele H Mokrzycki  2 , Kamalanathan K Sambandam  2 , Gaston E Zilleruelo  2 , Christoph Licht  2 , Matthew G Sampson  2 , Peter Song  2 , Laura H Mariani  2 , Matthias Kretzler  2
Affiliations
Multicenter Study

Complete Remission in the Nephrotic Syndrome Study Network

Debbie S Gipson et al. Clin J Am Soc Nephrol. .

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.

Keywords: cohort studies; focal segmental glomerulosclerosis; glomerular filtration rate; humans; kidney biopsy; kidney failure chronic, proteinuria; membranous nephropathy; minimal change disease; nephrotic syndrome.

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Figures

Figure 1.
Figure 1.
Participant disposition in the Nephrotic Syndrome Study Network. The most common reasons for study ineligibility pertained to the kidney biopsy eligibility criteria.
Figure 2.
Figure 2.
Distribution of glomerulopathies in the Nephrotic Syndrome Study Network cohort by age (in years) at enrollment. Minimal-change disease (MCD) was most common in younger ages, membranous nephropathy (MN) was primarily present in adults, and FSGS and other glomerulopathies were present in all ages.
Figure 3.
Figure 3.
Time to complete remission by cohort (unadjusted). Minimal-change disease (MCD) patients were the most likely to reach complete remission. FSGS, membranous nephropathy (MN), and other glomerulopathies showed similar remission patterns.
See this image and copyright information in PMC

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