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Abstract: SA-PO963

Proteinuria Trajectories Among Patients with Minimal Change Disease (MCD) and FSGS in NEPTUNE

Session Information

Category: Glomerular Diseases

  • 1402 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
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
Background

Proteinuria is a primary symptom of nephrotic syndrome and known risk factor for disease progression. Our objective was to identify patient-groups based on longitudinal proteinuria trajectories.

Methods

Patients with minimal change disease (MCD, n=151) and focal segmental glomerular sclerosis (FSGS, n=173) enrolled at the time of biopsy in the Nephrotic Syndrome Study Network (NEPTUNE) were included. Group based trajectory modeling was applied to UPCR measurements from the first 2 years post-biopsy; groups were compared on demographics, clinical presentation, histopathologic features, and eGFR trajectories.

Results

Three groups were identified; Group 1 (n=32) had low proteinuria on average over the first 2 years post-biopsy; Group 2 (n=130) had nephrotic range proteinuria at biopsy that resolved within the first year; Group 3 (n=162) had nephrotic range proteinuria across the 2 years post-biopsy (Figure). Groups 1 and 2 were majority MCD (90% and 58%, respectively); Group 3 was 72% FSGS. Group 3 had more of glomeruli with global sclerosis/obsolescence, segmental obliteration, podocyte abnormalities, interstitial fibrosis/tubular atrophy, interstitial inflammation, and endothelial cell abnormalities. Group 1 was more likely to be treated with immunosuppression (IST, mostly glucocorticoids) prior to biopsy (63%) compared to Groups 2 and 3 (38% and 24%, respectively). By 2 years post-biopsy 92%, 85%, and 66% of Groups 1, 2, and 3, respectively had been exposed to IST. After 2 years post-biopsy eGFR increased by 3.8 ml/min/1.73m2 per year on average in Group 1, and decreased by 2.2 and 4.6 ml/min/1.73m2 per year on average in Groups 2 and 3, respectively (p<0.001).

Conclusion

Proteinuria trajectories identified patient phenotypes that did not completely align with traditional histopathologic diagnosis. These groups also differ on baseline clinical and histopathologic features that may help predict response to treatment.

Average proteinuria trajectories by group.

Funding

  • NIDDK Support