Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings
BACKGROUND AND OBJECTIVES: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence.
METHODS: Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence.
RESULTS: We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence.
CONCLUSIONS: Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.
| Errataetall: |
ErratumIn: Pediatr Nephrol. 2019 Mar;34(3):539. - PMID 30443740 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Pediatric nephrology (Berlin, Germany) - 33(2018), 10 vom: 07. Okt., Seite 1773-1780 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pelletier, Jonathan H [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 27.09.2019 Date Revised 01.10.2019 published: Print-Electronic ErratumIn: Pediatr Nephrol. 2019 Mar;34(3):539. - PMID 30443740 Citation Status MEDLINE |
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| doi: |
10.1007/s00467-018-3994-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM286255987 |
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| 100 | 1 | |a Pelletier, Jonathan H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings |
| 264 | 1 | |c 2018 | |
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| 500 | |a Date Completed 27.09.2019 | ||
| 500 | |a Date Revised 01.10.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Pediatr Nephrol. 2019 Mar;34(3):539. - PMID 30443740 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence | ||
| 520 | |a METHODS: Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence | ||
| 520 | |a RESULTS: We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence | ||
| 520 | |a CONCLUSIONS: Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Focal segmental glomerulosclerosis | |
| 650 | 4 | |a Immunosuppression | |
| 650 | 4 | |a Lipoid | |
| 650 | 4 | |a Nephrosis | |
| 650 | 4 | |a Nephrotic syndrome | |
| 650 | 4 | |a Transplantation | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 700 | 1 | |a Kumar, Karan R |e verfasserin |4 aut | |
| 700 | 1 | |a Engen, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Bensimhon, Adam |e verfasserin |4 aut | |
| 700 | 1 | |a Varner, Jennifer D |e verfasserin |4 aut | |
| 700 | 1 | |a Rheault, Michelle N |e verfasserin |4 aut | |
| 700 | 1 | |a Srivastava, Tarak |e verfasserin |4 aut | |
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| 700 | 1 | |a Davis, T Keefe |e verfasserin |4 aut | |
| 700 | 1 | |a Wenderfer, Scott E |e verfasserin |4 aut | |
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| 700 | 1 | |a Selewski, David |e verfasserin |4 aut | |
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| 700 | 1 | |a Brewer, Eileen D |e verfasserin |4 aut | |
| 700 | 1 | |a Nagaraj, Shashi K |e verfasserin |4 aut | |
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