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Abstract: PO1874

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

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Nakayama, Maiko, Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Hitoshi, Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Kihara, Masao, Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Yusuke, Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
Background

Minimal change disease (MCD) is the most frequent cause of primary nephrotic syndrome (NS) in Japan. The response to steroid therapy is highly sensitive, and remission rates are over 90% in patients with MCD. However, recurrence rates are also high. Selectivity index (S.I.) of proteinuria using clearance ratio of IgG to transferrin is commonly used for initial examination to differentiate MCD. Whereas, there is no useful index of predictor for response to therapy in nephrotic syndrome. In present study, we evaluated clinical markers to predict the treatment response.

Methods

Of the 94 patients with NS who were performed renal biopsy in our hospital from 2013 to 2019, 60 patients with primary nephrotic syndrome were divided into complete remission group and incomplete remission group by initial treatment response. We examined whether clinical markers including eGFR, serum albumin and S.I. can predict initial treatment response. We further examined the association between S.I. and risk of relapse in patients with MCD.

Results

Forty-five of sixty patients with primary NS were complete remission group. In complete remission group, the incidence of MCD, idiopathic membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS) and membranoproliferative glomerulonephritis (MPGN) were 75%, 16%, 7%, and 2%, respectively. The S.I. was significantly lower in the complete remission group than in the incomplete remission group (P<0.01). And, the S.I. in the complete remission group was less than 0.2 in any underlying diseases. Thus, regardless of the primary underlying disease, NS patients with low S.I. may have high remission rate after initial prednisolone (PSL) therapy. In patients with MCD, the relapse group showed the higher level of urine IgG and transferrin compared with the remission maintenance group (P<0.05), although the level of S.I. was the same degree. The remission rate and recurrence rate were not correlated with age, levels of serum albumin, creatinine, eGFR, IgG or urinary protein.

Conclusion

Regardless of the causal diseases of NS, the patients with S.I. less than 0.2 have good response to PSL treatment. Moreover, it is suggested that S.I. as well as levels of urinary IgG and transferrin may be useful to assess the risk of recurrence in patients with MCD.