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Abstract: SA-PO704

Comparing Outcomes of Patients With and Without Nephrotic Syndrome in Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Son, Hyung Eun, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, Korea (the Republic of)
  • Park, Seokwoo, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
Background

Minimal change lesion (MCD) is characterized by edema, nephrotic ranged proteinuria (NS). However, the fate of MCD without nephrotic proteinuria needs to be defined in more detail.

Methods

We enrolled 79 adult MCD patients with the first renal biopsy in a tertiary hospital from May 2003 to June 2017. We did not include patients having any immunosuppressive treatment before renal biopsy, patients with inappropriate biopsy samples (<10 glomeruli/biopsy, any electron dense deposit, and light microscopic findings suggestive secondary causes). Remission of proteinuria was defined as urine protein to creatinine ratio (UPCR) < 0.3 g/g creatinine and relapse of proteinuria as UPCR ≥ 3.0 g/g creatinine. Clinic-pathologic features were compared between patients with and without NS. We followed up with the frequency of flare to nephrotic proteinuria, and renal outcomes such as the decrease of estimated glomerular filtration rate (GFR) over 50% compared to GFR at renal biopsy, GFR < 15 ml/min/1.73 m2, or progression to end stage renal disease during follow-up period.

Results

There were 3 patients with UPCR < 0.3 g/g creatinine, 17 patients with UPCR 0.3-2.9 g/g creatinine, and 59 patients with UPCR ≥ 3.0 g/g creatinine at admission for renal biopsy. Mean age at renal biopsy was 53.7 ± 19.2 (range:18.5-99.0) years, and there were 38 male patients (48.1%). Each group included 20 patients (Non-NS group), and 59 patients (NS group). Non-NS group had lower UPCR (1.36 ± 0.99 vs 10.2 ± 6.21 g/g creatinine, p<0.001) and higher GFR (98 ± 27 vs 75 ± 36 ml/min/1.73 m2, p=0.012) at renal biopsy. Non-NS group had lower frequency of AKI during follow-up period [5.0% vs 59.3%, p < 0.001]. Response rate to steroid treatment was 100 % in Non-NS group and 92.3 % in NS group (p = 1.000). There was no difference in the frequency of the first relapse and the number of relapses. At the final visit, the CR rate was 73.4 %. The eGFR during follow-up was much improved in NS group compared to Non-NS group because of higher incidence of AKI at renal biopsy. The incidence rate of renal event, ESRD event, or mortality was not different between groups.

Conclusion

The adult MCD patients with nephrotic and non-nephrotic ranged proteinuria showed similar outcomes. Therefore, MCD should be paid more attention regardless of the amount of proteinuria at renal biopsy.