Novel inflammation biomarkers in adult minimal change disease: predicting steroid-resistance and relapse

The novel systemic inflammation markers are a class of indicators combining clinically common laboratory indices, reflecting the underlying immune and inflammatory status. Minimal change disease (MCD) is an important cause of idiopathic nephrotic syndrome (INS) in adults. Novel systemic inflammation markers were evaluated for their ability to predict treatment response to steroids and subsequent relapse in adult-onset MCD.

This unicentric, retrospective study included the clinical data of adult-onset INS patients who were pathologically diagnosed with MCD at Xiangya Hospital of Central South University from January 2010 to December 2021 and followed up with the patients' remission after adequate steroid treatment, starting from the time of initial complete remission to May 31, 2022, with recurrence as the end-point event. Eight common and associated novel systemic inflammation markers were collected, and univariate analysis of these markers was performed using dummy variable assignment or maximally selected rank statistics. Multivariate logistic regression and Cox regression statistics identified the independent risk factors for steroid resistance and relapse after initial remission in adult-onset MCD, respectively.

A total of 121 patients were included; the median age was 22 (19,40) years, and there were 92 (76%) men. Adequate corticosteroids were the initial treatment: 98 (81%) patients achieved remission, and 23 (19%) developed steroid resistance. Of the 98 patients with remission, the median age was 25 (19, 44) years, 76 (77.6%) were male, the median follow-up time was 11.4 (6.3, 33.4) months, and 46 (46.9%) experienced relapse. The multivariate analysis showed that elevated C-reactive protein to albumin ratio (CAR) (≥ 0.196) and derived neutrophil/ (leukocyte minus neutrophil) ratio (dNLR) (≥ 1.32) were independent predictors of steroid resistance and relapse in adult-onset MCD, respectively.

The novel systemic inflammation markers CAR and dNLR may play significant roles in steroid treatment and the prognosis of MCD in adults, and deeper clinical studies in the future are warranted.