Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;25(3):240-250.
doi: 10.1007/s10157-020-01985-7. Epub 2020 Oct 22.

Adult-onset minimal change disease: the significance of histological chronic changes for clinical presentation and outcome

Gabriel Stefan #  1 , Ruxandra Busuioc #  2 , Simona Stancu  2   3 , Madalina Hoinoiu  3 , Adrian Zugravu  2   3 , Nicoleta Petre  2   3 , Gabriel Mircescu  2   3
Affiliations

Adult-onset minimal change disease: the significance of histological chronic changes for clinical presentation and outcome

Gabriel Stefan et al. Clin Exp Nephrol. 2021 Mar.

Abstract

Introduction: Data on pathologic features with prognostic utility in adults with minimal change disease (MCD) are limited. We assessed the relationship between histologic chronic changes and clinical presentation and outcomes.

Methods: The consecutive records of 79 patients with MCD and minimum of 6 months follow-up were retrospectively reviewed. Kidney survival was the primary endpoint (doubling serum creatinine or dialysis initiation). Secondary endpoints were time to remission and relapse. Total chronicity score was the sum of glomerulosclerosis (0-3), interstitial fibrosis (0-3), tubular atrophy (0-3), and arteriolosclerosis (0/1).

Results: The median renal chronicity score was 1; 77% had minimal (0-1), 18% mild (2-4), and 5% moderate (5-7) chronicity. Fifty percent had a null score; they were younger, had higher eGFR, similar proteinuria, better renal survival, and lower mortality. Mean kidney survival time was 5.7 (95% CI 5.2-6.2) years; 89% reached a form of remission at a median of 8 weeks; 31% relapsed at a mean of 26 months. Chronic changes severity predicted both relapses and kidney survival, each one-point increase in score raised with 27% the risk of relapse and with 31% the risk of dialysis initiation. Acute kidney injury (AKI) was present in 42% of the patients; they had more often mesangial proliferation, interstitial inflammation, tubular atrophy, arteriosclerosis, podocyte villous hypertrophy, and higher chronicity score.

Conclusion: Standardized grading of chronicity was a predictor of kidney survival and disease relapse and was related to AKI. Older patients with severe nephrotic syndrome and with increased chronicity score could represent a high-risk category.

Keywords: Acute kidney injury; Kidney survival; Minimal change disease; Nephrotic syndrome; Renal chronicity score.

PubMed Disclaimer

References

    1. Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362(9384):629–39. https://doi.org/10.1016/S0140-6736(03)14184-0 . - DOI - PubMed
    1. Vivarelli M, Massella L, Ruggiero B, Emma F. Minimal change disease. Clin J Am Soc Nephrol. 2017;12(2):332–45. https://doi.org/10.2215/CJN.05000516 . - DOI - PubMed
    1. Haas M, Meehan SM, Karrison TG, Spargo BH. Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976–1979 and 1995–1997. Am J Kidney Dis. 1997;30(5):621–31. https://doi.org/10.1016/s0272-6386(97)90485-6 . - DOI - PubMed
    1. Nakayama M, Katafuchi R, Yanase T, Ikeda K, Tanaka H, Fujimi S. Steroid responsiveness and frequency of relapse in adult-onset minimal change nephrotic syndrome. Am J Kidney Dis. 2002;39(3):503–12. https://doi.org/10.1053/ajkd.2002.31400 . - DOI - PubMed
    1. Mak SK, Short CD, Mallick NP. Long-term outcome of adult-onset minimal-change nephropathy. Nephrol Dial Transplant. 1996;11(11):2192–201. https://doi.org/10.1093/oxfordjournals.ndt.a027136 . - DOI - PubMed

MeSH terms

LinkOut - more resources