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- Title
Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings.
- Authors
Pelletier, Jonathan H.; Kumar, Karan R.; Engen, Rachel; Bensimhon, Adam; Varner, Jennifer D.; Rheault, Michelle N.; Srivastava, Tarak; Straatmann, Caroline; Silva, Cynthia; Davis, T. Keefe; Wenderfer, Scott E.; Gibson, Keisha; Selewski, David; Barcia, John; Weng, Patricia; Licht, Christoph; Jawa, Natasha; Kallash, Mahmoud; Foreman, John W.; Wigfall, Delbert R.
- Abstract
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.
- Subjects
KIDNEY disease diagnosis; KIDNEY disease risk factors; NEPHROTIC syndrome diagnosis; DISEASE relapse; ADRENOCORTICAL hormones; FOCAL segmental glomerulosclerosis; BIOPSY; CHRONIC kidney failure; CONFIDENCE intervals; DRUG resistance; GRAFT versus host reaction; HOMOGRAFTS; IMMUNOSUPPRESSION; KIDNEY transplantation; MEDICAL cooperation; MULTIVARIATE analysis; NEPHROTIC syndrome; RESEARCH; SURGICAL complications; LOGISTIC regression analysis; ODDS ratio; DISEASE complications; DIAGNOSIS; SURGERY; DISEASE risk factors; THERAPEUTICS
- Publication
Pediatric Nephrology, 2018, Vol 33, Issue 10, p1773
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-018-3994-3