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Kidney Week

Abstract: FR-PO055

AKI and Remission of Proteinuria in Adult-Onset Minimal Change Disease: A Multicenter Retrospective Cohort Study

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Shinzawa, Maki, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Nagasawa, Yasuyuki, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Yamamoto, Ryohei, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Yamauchi, Atsushi, Osaka Rosai Hospital, Sakai-city, Japan
  • Fukunaga, Megumu, Toyonaka Municipal Hospital, Toyonaka, Japan
  • Hayashi, Terumasa, Osaka General Medical Center, Osaka, Japan
  • Izumi, Masaaki, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Group or Team Name

  • STOP-MCD
Background

Acute kidney injury (AKI) is common (20% to 50%) in adult-onset minimal change disease (MCD). However, its effect on remission of proteinuria is unknown.

Methods

Design: a multicenter retrospective cohort study, the STudy of Outcomes and Practice patterns of Minimal-Change Disease (STOP-MCD).
Patients: 117 nephrotic patients aged ≥15 years with histological diagnosis of primary MCD between 2000 and 2009 in 5 hospitals in Japan.
Outcome: First remission of proteinuria defined as urinary protein < 0.3 g/day, urinary protein / creatinine ratio < 0.3, and/or negative/trace result of dipstick test.
Exposure: AKI defined as ≥0.3mg/dL of an increase of creatinine (Cre) at initiating immunosuppressive therapy.
Statistics: Multivariable Cox proportional hazards (CPH) model.

Results

Baseline characteristics at initiating of immunosuppressive therapy.of AKI group (n=29) and non-AKI group (n=88) were as follows; age, median 53 [interquantile range 28, 63] vs. 37 [22, 58] yr (P=0.135); male, 66 vs. 61 % (P=0.689); Cre, 1.6 [1.3, 2.0] vs. 0.8 [0.7, 0.9] mg/dL (P<0.001); serum albumin, mean 1.8 ± SD 0.6 vs. 1.8 ± 0.6 g/L (P=0.950); urinary protein, 11.6 [7.9, 14.7] vs. 7.2 [3.3, 14.4]) g/day (P=0.021); initial dose of prednisolone, 0.7 ± 0.1vs. 0.7 ± 0.2 mg/Kg (P=0.449).
During 4.2 [2.2-7.2] year of the observational period, all patient achieved remission.
Maximum Cre after initial treatment was 2.5 [2.0-3.6] mg./dL in AKI group and 0.9 [0.8-1.2] mg/dL in non-AKI group.
Remission was delayed in AKI group (27 [19, 45] vs. 12 [9, 24] day, P=0.002) (Figure). AKI was identified as a significant predictor of remission in the multivariable CPH model (AKI vs. non-AKI, hazard ratio 0.48 [95% confidence interval 0.29-0.79, P=0.004]).

Conclusion

AKI before immunosuppressive therapy delayed remission of proteinuria in adult-onset MCD.

Funding

  • NIDDK Support