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.
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.
Authors: Laura Barisoni; Cynthia C Nast; J Charles Jennette; Jeffrey B Hodgin; Andrew M Herzenberg; Kevin V Lemley; Catherine M Conway; Jeffrey B Kopp; Matthias Kretzler; Christa Lienczewski; Carmen Avila-Casado; Serena Bagnasco; Sanjeev Sethi; John Tomaszewski; Adil H Gasim; Stephen M Hewitt Journal: Clin J Am Soc Nephrol Date: 2013-02-07 Impact factor: 8.237
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Authors: Crystal A Gadegbeku; Debbie S Gipson; Lawrence B Holzman; Akinlolu O Ojo; Peter X K Song; Laura Barisoni; Matthew G Sampson; Jeffrey B Kopp; Kevin V Lemley; Peter J Nelson; Chrysta C Lienczewski; Sharon G Adler; Gerald B Appel; Daniel C Cattran; Michael J Choi; Gabriel Contreras; Katherine M Dell; Fernando C Fervenza; Keisha L Gibson; Larry A Greenbaum; Joel D Hernandez; Stephen M Hewitt; Sangeeta R Hingorani; Michelle Hladunewich; Marie C Hogan; Susan L Hogan; Frederick J Kaskel; John C Lieske; Kevin E C Meyers; Patrick H Nachman; Cynthia C Nast; Alicia M Neu; Heather N Reich; John R Sedor; Christine B Sethna; Howard Trachtman; Katherine R Tuttle; Olga Zhdanova; Gastòn E Zilleruelo; Matthias Kretzler Journal: Kidney Int Date: 2013-01-16 Impact factor: 10.612
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Authors: Marie C Hogan; Heather N Reich; Peter J Nelson; Sharon G Adler; Daniel C Cattran; Gerald B Appel; Debbie S Gipson; Matthias Kretzler; Jonathan P Troost; John C Lieske Journal: Kidney Int Date: 2016-08-12 Impact factor: 10.612
Authors: Hanna Debiec; Claire Dossier; Eric Letouzé; Christopher E Gillies; Marina Vivarelli; Rosemary K Putler; Elisabet Ars; Evelyne Jacqz-Aigrain; Valery Elie; Manuela Colucci; Stéphanie Debette; Philippe Amouyel; Siham C Elalaoui; Abdelaziz Sefiani; Valérie Dubois; Tabassome Simon; Matthias Kretzler; Jose Ballarin; Francesco Emma; Matthew G Sampson; Georges Deschênes; Pierre Ronco Journal: J Am Soc Nephrol Date: 2018-06-14 Impact factor: 10.121
Authors: Musab S Hommos; An S De Vriese; Mariam P Alexander; Sanjeev Sethi; Lisa Vaughan; Ladan Zand; Kharmen Bharucha; Nicola Lepori; Andrew D Rule; Fernando C Fervenza Journal: Mayo Clin Proc Date: 2017-10-27 Impact factor: 7.616