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Predictors of Relapse in Adult-Onset Nephrotic Minimal Change Disease

View Article: PubMed Central - PubMed

ABSTRACT

Minimal change disease (MCD) is a well-known benign primary glomerulonephritis because of its distinct rare tendency to progress to end-stage renal disease. However, factors associated with relapse in adults are not well known. We aimed to identify predictors of relapse in adult-onset MCD patients.

A retrospective cohort of 195 patients with adult-onset primary MCD with nephritic syndrome and disease onset between 1979 and 2013 was followed up for >12 months. The number of relapses was counted and predictors of relapse were analyzed.

A total of 195 patients were included. Median age at diagnosis was 38 years (IQR, 23–53 years) and 113 (57.9%) were men. During 81 months (IQR, 44–153 months) of follow-up, 92% of patients achieved remission after initial treatment. However, only 60 (32.8%) did not experience a relapse and 11 patients failed to remit. Among the remaining 124 patients, 65 experienced a relapse once or twice and 59 experienced a relapse more than twice. Younger onset age, increased severity of nephrotic features such as lower serum albumin levels and higher cholesterol level were associated with relapse. Interestingly, the grade of mesangial proliferation was lower in patients who experienced a relapse. Initial combined treatment with corticosteroids (CS) and cyclophosphamide reduced the number of relapses. In addition, patients with shorter treatment duration tended to experience relapse more often. Multivariate analysis showed that younger onset age, combined mesangial proliferation, initial treatment regimen, and treatment duration were independent risk factors for relapse. Progression to end-stage renal disease was developed in only a patient.

In conclusion, more than two-thirds of adult-onset nephrotic MCD patients experienced relapse, although their renal progression was rare. Younger onset age, CS without cyclophosphamide treatment, and shorter treatment duration were independent risk factors for relapse in adult-onset MCD patients.

No MeSH data available.


Related in: MedlinePlus

Distribution of the number of relapse (A) and time to relapse (B). X-bar means the number of relapse and y-bar means the number of patients (A). Label B shows the relapse-free survival in adult MCD patients. Time to relapse is categorized at regular intervals of 24 weeks, and the numbers of patients remaining are shown at the bottom.
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Figure 2: Distribution of the number of relapse (A) and time to relapse (B). X-bar means the number of relapse and y-bar means the number of patients (A). Label B shows the relapse-free survival in adult MCD patients. Time to relapse is categorized at regular intervals of 24 weeks, and the numbers of patients remaining are shown at the bottom.

Mentions: Relapse of NS occurred in 131 (67.2%) initial responders. The number of total relapse is shown in Figure 2A. About one-fourth of patients experienced relapse only once after MCD diagnosis, another two-fifth of patients experienced relapse 2 or 3 times, and one-third experienced relapse more than 3 times. The maximum number of relapses was 33 in a patient with extremely poor treatment compliance that resulted in a relapse every 3 to 6 months. The median annual number of relapses was 0.20 (IQR 0–0.52). The median time to first relapse was 14 weeks (IQR 0–55 weeks). In almost half of relapse patients, first relapse occurred within the first 3 months of diagnosis, as shown in Figure 2B, although in some cases, relapse occurred 5 years after diagnosis. Thirty-nine patients experienced relapse of NS during tapering of immunosuppressant dose. Twenty-one patients experienced relapse within 3 months after cessation of immunosuppressant therapy.


Predictors of Relapse in Adult-Onset Nephrotic Minimal Change Disease
Distribution of the number of relapse (A) and time to relapse (B). X-bar means the number of relapse and y-bar means the number of patients (A). Label B shows the relapse-free survival in adult MCD patients. Time to relapse is categorized at regular intervals of 24 weeks, and the numbers of patients remaining are shown at the bottom.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998403&req=5

Figure 2: Distribution of the number of relapse (A) and time to relapse (B). X-bar means the number of relapse and y-bar means the number of patients (A). Label B shows the relapse-free survival in adult MCD patients. Time to relapse is categorized at regular intervals of 24 weeks, and the numbers of patients remaining are shown at the bottom.
Mentions: Relapse of NS occurred in 131 (67.2%) initial responders. The number of total relapse is shown in Figure 2A. About one-fourth of patients experienced relapse only once after MCD diagnosis, another two-fifth of patients experienced relapse 2 or 3 times, and one-third experienced relapse more than 3 times. The maximum number of relapses was 33 in a patient with extremely poor treatment compliance that resulted in a relapse every 3 to 6 months. The median annual number of relapses was 0.20 (IQR 0–0.52). The median time to first relapse was 14 weeks (IQR 0–55 weeks). In almost half of relapse patients, first relapse occurred within the first 3 months of diagnosis, as shown in Figure 2B, although in some cases, relapse occurred 5 years after diagnosis. Thirty-nine patients experienced relapse of NS during tapering of immunosuppressant dose. Twenty-one patients experienced relapse within 3 months after cessation of immunosuppressant therapy.

View Article: PubMed Central - PubMed

ABSTRACT

Minimal change disease (MCD) is a well-known benign primary glomerulonephritis because of its distinct rare tendency to progress to end-stage renal disease. However, factors associated with relapse in adults are not well known. We aimed to identify predictors of relapse in adult-onset MCD patients.

A retrospective cohort of 195 patients with adult-onset primary MCD with nephritic syndrome and disease onset between 1979 and 2013 was followed up for >12 months. The number of relapses was counted and predictors of relapse were analyzed.

A total of 195 patients were included. Median age at diagnosis was 38 years (IQR, 23–53 years) and 113 (57.9%) were men. During 81 months (IQR, 44–153 months) of follow-up, 92% of patients achieved remission after initial treatment. However, only 60 (32.8%) did not experience a relapse and 11 patients failed to remit. Among the remaining 124 patients, 65 experienced a relapse once or twice and 59 experienced a relapse more than twice. Younger onset age, increased severity of nephrotic features such as lower serum albumin levels and higher cholesterol level were associated with relapse. Interestingly, the grade of mesangial proliferation was lower in patients who experienced a relapse. Initial combined treatment with corticosteroids (CS) and cyclophosphamide reduced the number of relapses. In addition, patients with shorter treatment duration tended to experience relapse more often. Multivariate analysis showed that younger onset age, combined mesangial proliferation, initial treatment regimen, and treatment duration were independent risk factors for relapse. Progression to end-stage renal disease was developed in only a patient.

In conclusion, more than two-thirds of adult-onset nephrotic MCD patients experienced relapse, although their renal progression was rare. Younger onset age, CS without cyclophosphamide treatment, and shorter treatment duration were independent risk factors for relapse in adult-onset MCD patients.

No MeSH data available.


Related in: MedlinePlus