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Complete Remission in the Nephrotic Syndrome Study Network.

Debbie S Gipson1, Jonathan P Troost2, Richard A Lafayette2

  • 1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. dgipson@med.umich.edu.

Clinical Journal of the American Society of Nephrology : CJASN
|December 15, 2015
PubMed
Summary

Complete proteinuria remission (CRever) was achieved by 46% of patients with proteinuric kidney disease. Lower prebiopsy proteinuria and specific pathology diagnoses were linked to higher remission rates in this NEPTUNE study.

Keywords:
cohort studiesfocal segmental glomerulosclerosisglomerular filtration ratehumanskidney biopsykidney failure chronic, proteinuriamembranous nephropathyminimal change diseasenephrotic syndrome

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Area of Science:

  • Nephrology
  • Glomerular Diseases
  • Renal Pathology

Background:

  • The Nephrotic Syndrome Study Network (NEPTUNE) investigated proteinuric patients requiring kidney biopsies.
  • Understanding factors influencing complete proteinuria remission (CRever) is crucial for patient outcomes.

Purpose of the Study:

  • To assess phenotypic and pathology characteristics in proteinuric patients.
  • To determine the frequency of CRever and identify associated factors.

Main Methods:

  • Prospective cohort study of 441 proteinuric patients undergoing renal biopsy.
  • Participants categorized into minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts.
  • Cox proportional hazards modeling used to analyze factors associated with CRever.

Main Results:

  • 46% of patients achieved CRever; 4.6% progressed to end-stage renal disease (ESRD).
  • Higher prebiopsy proteinuria and FSGS diagnosis (vs. MCD) were inversely associated with CRever.
  • Immunosuppressive therapy effects on remission varied by pathology.

Conclusions:

  • The high frequency of diverse pathologies underscores the importance of diagnostic kidney biopsy.
  • Proteinuria levels, pathology diagnosis, and immunosuppression influence CRever in proteinuric kidney disease.