Kidney Week

Abstract: FR-PO0663

Revisiting Remission Definitions in Primary Podocytopathy

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Laxamana, Trisha D., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Trisha D. Laxamana, MD

• Vargas-Brochero, Maria J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Maria J. Vargas-Brochero, MD, MS

• Cara, Anila, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Anila Cara, MD

• Juanet, Cristián, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Cristián Juanet, MD

• Barbarini, Michele, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Michele Barbarini, MD, MBBS

• Arriola Montenegro, Jose J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Jose J. Arriola Montenegro, MD

• Berti, Gian Marco, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Gian Marco Berti, MD, PhD

• Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Fernando C. Fervenza, MD, PhD, FASN

• Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Ladan Zand, MD

Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are primary podocytopathies in which proteinuria is a major marker of disease activity and a key therapeutic target. Current KDIGO remission definitions, complete remission (CR; <0.3 g/day) and partial remission (PR; 0.3–3.5 g/day), were largely derived from historical studies and expert consensus. However, whether these cutoffs optimally predict long-term renal risk remains uncertain. We therefore evaluated whether alternative proteinuria thresholds could more effectively predict renal outcomes and kidney function trajectory in a well-defined cohort of biopsy-proven primary podocytopathies.

Methods

Retrospective cohort study of adults with nephrotic syndrome and biopsy-proven primary podocytopathies (n=143). Proteinuria was assessed at remission, 6 months, 12 months, and as time-averaged proteinuria. Outcomes were renal event (end stage kidney disease or ≥40% eGFR decline) and eGFR slope. Statistical analyses included Kaplan–Meier survival analysis, cox proportional hazards models, and linear mixed-effects models.

Results

Using KDIGO definitions, PR did not significantly discriminate risk from CR (HR 4.41, p=0.149), with similar 60-month event-free survival (~95% vs ~90%). A data-driven cutoff of 0.8 g/day improved risk stratification, with no additional events between 0.3–0.8 g/day; 60-month event-free survival was ~97% (<0.8) vs ~87% (0.8–3.5) (HR 5.72, p=0.02). Achieving proteinuria ≤2.15 g/day at 6 months and ≤1.5 g/day at 12 months was associated with favorable long-term renal outcomes. Lower time averaged proteinuria (<0.9 g/day) was associated with eGFR gain (+1.98 mL/min/1.73 m2/yr), 0.9–3.5 g/day with minimal gain (+1.02), whereas >3.5 g/day was associated with eGFR decline (−4.72).

Conclusion

In a well-defined primary podocytopathy cohort, proteinuria strongly predicted renal outcomes. However, the current CR threshold of <0.3 g/day may be overly stringent. The <0.8 g/day cutoff better discriminated against longterm risk and may retain prognostic accuracy while being more clinically practical.