Complete Remission in the Nephrotic Syndrome Study Network

Debbie S Gipson; Jonathan P Troost; Richard A Lafayette; Michelle A Hladunewich; Howard Trachtman; Crystal A Gadegbeku; John R Sedor; Lawrence B Holzman; Marva M Moxey-Mims; Kalyani Perumal; Frederick J Kaskel; Peter J Nelson; Katherine R Tuttle; Serena M Bagnasco; Marie C Hogan; Katherine M Dell; Gerald B Appel; John C Lieske; Titilayo O Ilori; Christine B Sethna; Fernando C Fervenza; Susan L Hogan; Patrick H Nachman; Avi Z Rosenberg; Larry A Greenbaum; Kevin E C Meyers; Stephen M Hewitt; Michael J Choi; Jeffrey B Kopp; Olga Zhdanova; Jeffrey B Hodgin; Duncan B Johnstone; Sharon G Adler; Carmen Avila-Casado; Alicia M Neu; Sangeeta R Hingorani; Kevin V Lemley; Cynthia C Nast; Tammy M Brady; Laura Barisoni-Thomas; Alessia Fornoni; J Charles Jennette; Daniel C Cattran; Matthew B Palmer; Keisha L Gibson; Heather N Reich; Michele H Mokrzycki; Kamalanathan K Sambandam; Gaston E Zilleruelo; Christoph Licht; Matthew G Sampson; Peter Song; Laura H Mariani; Matthias Kretzler

doi:10.2215/CJN.02560315

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Complete Remission in the Nephrotic Syndrome Study Network

Journal article

Open access

Complete Remission in the Nephrotic Syndrome Study Network

Debbie S Gipson, Jonathan P Troost, Richard A Lafayette, Michelle A Hladunewich, Howard Trachtman, Crystal A Gadegbeku, John R Sedor, Lawrence B Holzman, Marva M Moxey-Mims, Kalyani Perumal, …

Clinical journal of the American Society of Nephrology, Vol.11(1), pp.81-89

2016-01-07

DOI: https://doi.org/10.2215/CJN.02560315

PMCID: PMC4702222

PMID: 26656320

Abstract

Glomerular Filtration Rate

Prospective Studies

Kidney - pathology

Outcome Assessment (Health Care)

Humans

Middle Aged

Proportional Hazards Models

Nephrotic Syndrome - pathology

Male

Nephrotic Syndrome - drug therapy

Remission Induction

Proteinuria - physiopathology

Nephrotic Syndrome - complications

Biopsy

Nephrotic Syndrome - physiopathology

Adolescent

Adult

Female

Cohort Studies

Kidney Failure, Chronic - etiology

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). 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. 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. 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.

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Citation topics: 1 Clinical & Life Sciences; 1.55 Urology & Nephrology - General; 1.55.820 IgA Nephropathy
Web Of Science research areas: Urology & Nephrology
ESI research areas: Clinical Medicine

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Title: Complete Remission in the Nephrotic Syndrome Study Network
Creators: Debbie S Gipson - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. dgipson@med.umich.edu
Jonathan P Troost - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Richard A Lafayette - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Michelle A Hladunewich - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Howard Trachtman - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Crystal A Gadegbeku - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
John R Sedor - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Lawrence B Holzman - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Marva M Moxey-Mims - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Kalyani Perumal - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Frederick J Kaskel - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Peter J Nelson - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Katherine R Tuttle - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Serena M Bagnasco - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Marie C Hogan - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Katherine M Dell - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Gerald B Appel - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
John C Lieske - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Titilayo O Ilori - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Christine B Sethna - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Fernando C Fervenza - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Susan L Hogan - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Patrick H Nachman - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Avi Z Rosenberg - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Larry A Greenbaum - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Kevin E C Meyers - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Stephen M Hewitt - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Michael J Choi - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Jeffrey B Kopp - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Olga Zhdanova - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Jeffrey B Hodgin - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Duncan B Johnstone - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Sharon G Adler - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Carmen Avila-Casado - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Alicia M Neu - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Sangeeta R Hingorani - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Kevin V Lemley - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Cynthia C Nast - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Tammy M Brady - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Laura Barisoni-Thomas - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Alessia Fornoni - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
J Charles Jennette - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Daniel C Cattran - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Matthew B Palmer - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Keisha L Gibson - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Heather N Reich - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Michele H Mokrzycki - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Kamalanathan K Sambandam - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Gaston E Zilleruelo - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Christoph Licht - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Matthew G Sampson - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Peter Song - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Laura H Mariani - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Matthias Kretzler - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Publication Details: Clinical journal of the American Society of Nephrology, Vol.11(1), pp.81-89
Publisher: United States
Grant note: U54 DK083912 / NIDDK NIH HHS U54DK083912 / NIDDK NIH HHS P30 DK092926 / NIDDK NIH HHS UL1 TR000439 / NCATS NIH HHS K23 HL119622 / NHLBI NIH HHS
Academic Unit: Miller School of Medicine; Peggy and Harold Katz Family Drug Discovery Center; UMMG Department of Pediatrics; UMMG Dept of Pediatrics - Nephrology
Language: English
Resource Type: Journal article
PMID: 26656320
PMCID: PMC4702222
Record Identifier: 991031562095402976