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Kidney Week

Abstract: SA-PO720

Proteinuria Selectivity Index as a Predictor for Response to Therapy in Nephrotic Syndrome

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Nakayama, Maiko, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Hitoshi, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
Background

The nephrotic syndrome (NS) is defined by heavy proteinuria due to abnormal increase of glomerular permeability and following hypoalbuminemia, hyperlipidemia and edema. Clinical manifestation of NS is highly variable due to the response to therapy. Selectivity index (S.I.) that commonly used for initial examination to differentiate minimal change disease (MCD). However, clinical application of S.I. is controversial for reliability. In present study, we evaluated clinical examinations including S.I. and prognosis of NS.

Methods

We retrospectively analysed 66 cases with NS who underwent renal biopsy in our hospital from 2013 to 2017. The clinical features at the time of renal biopsy, remission rate of initial therapy, and relapse rate of during the course of medication were evaluated in each primary glomerulonephritis.

Results

Of the 66 cases of NS, 47 cases were caused by primary glomerulonephritis. The incidence of MCD, idiopathic membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS) and membranoproliferative glomerulonephritis (MPGN) were 55%, 32%, 9%, and 4%, respectively. Prevalence of each causal disease of NS was similar to data of Japanese renal biopsy registry. At the time of renal biopsy, levels of proteinuria (6.9g/day), degree of hypoalbuminemia (1.6 g/dL) and dyslipidemia in MCD were most severe as compared with other primary glomerulonephritis (P=0.02). Complete remission rate of initial therapy in each primary glomerular disease were 96% for MCD, 57% for MN, 50% for FSGS and 50% for MPGN, respectively. However, 42.3% patients with MCD recurred during the course of immunosuppression therapy, despite high frequency of remission. Of note, patients with 67% of MN and 75% of FSGS indicated high S.I. (less than 0.2). There was the trend that in cases with high S.I. patients with MN and FSGS indicated high remission rate by initial therapy.

Conclusion

Although levels of proteinuria and degree of hypoalbuminemia were most severe in MCD, remission rate of MCD was high by initial therapy. The recurrence rate is also high in patients with MCD. The high S.I. may be useful to expect response to initial therapy in patients with MN and FSGS.