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Abstract: TH-PO479

Longitudinal Proteinuria Trajectories and Their Association With Kidney Failure in Minimal Change Disease and Focal Segmental Glomerulosclerosis: A CureGN Study

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Smith, Abigail R., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Helmuth, Margaret, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Achanti, Anand, Medical University of South Carolina, Charleston, South Carolina, United States
  • Almaani, Salem, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Aviles, Diego H., LSU Health New Orleans, New Orleans, Louisiana, United States
  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Canetta, Pietro A., Columbia University Irving Medical Center, New York, New York, United States
  • Cattran, Daniel C., University of Toronto, Toronto, Ontario, Canada
  • Chen, Dhruti P., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Drexler, Yelena, University of Miami School of Medicine, Miami, Florida, United States
  • Fornoni, Alessia, University of Miami Health System, Miami, Florida, United States
  • Gipson, Debbie, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Kaskel, Rick, Albert Einstein College of Medicine, Bronx, New York, United States
  • Kopp, Jeffrey B., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Laurin, Louis-Philippe, Universite de Montreal, Montreal, Quebec, Canada
  • Rizk, Dana, UAB Health System, Birmingham, Alabama, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Steinke, Julia M., Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, United States
  • Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States
Background

Proteinuria often guides treatment decisions and measures response in glomerular disease. We characterized longitudinal proteinuria trajectories in patients with MCD and FSGS and assessed associations with kidney failure (KF).

Methods

Participants with MCD and FSGS enrolled in the Cure Glomerulonephropathy (CureGN) study with a first diagnostic kidney biopsy in the 5 years prior to enrollment and ≥2 years of follow-up were included. Participants were grouped based on proteinuria trajectory in the first 2 years post-enrollment using latent class trajectory analysis. Associations between group membership and incidence of KF beyond 2 years post enrollment were assessed using multivariable Cox regression.

Results

887 participants (423 MCD, 464 FSGS) were included. Median age was 17 years (IQR 8-44); 53% were male; 22% were Black. Median follow-up time from enrollment was 4.5 years (IQR 3.4-5.7). Mean (SD) eGFR (ml/min/1.73m2) and UPCR (g/g) at enrollment were 89.3 (33.0) and 2.5 (3.2), respectively. Three groups were identified (Figure); Group 1 (78%) had consistently low UPCR (<1); Group 2 (12%) had high UPCR at enrollment that decreased by the start of year 2 to <2; Group 3 (10%) had consistently high UPCR (>6). Groups 1 and 2 were approximately evenly split between MCD and FSGS (48% and 52% for Group 1, 56% and 44% for Group 2), while Group 3 was predominantly FSGS (65%). Group 3 had higher hazard of progression to KF after 2 years post-enrollment compared to Group 1 (HR=3.4, 95% CI=1.6-7.3), after adjusting for diagnosis, age, eGFR at enrollment, and years from biopsy to enrollment. No interaction between diagnosis and proteinuria trajectory was detected (p=0.24).

Conclusion

Longitudinal proteinuria trajectories add additional information beyond diagnosis and baseline disease severity when characterizing risk of KF in patients with MCD and FSGS.

Mean UPCR trajectories with 95% confidence intervals.

Funding

  • NIDDK Support