Kidney Week

Abstract: FR-PO0642

Serum Lipidomic Profiles for Distinguishing Primary FSGS from Minimal Change Disease in Patients with Nephrotic Syndrome

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

• Li, Dazhong, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Dazhong Li, MBBS

• Zhao, Shengji, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Shengji Zhao, MS, MSc

• Cho, Bo Gyeong, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Bo Gyeong Cho

• Choi, Da Som, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)

Da Som Choi, MD

• Lee, Jung Pyo, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Jung Pyo Lee, MD, PhD

• Lee, Jeonghwan, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea (the Republic of)

Jeonghwan Lee, MD, PhD

Background

This study aimed to identify serum lipidomic biomarkers that could differentiate primary focal segmental glomerulosclerosis (FSGS) from minimal change disease (MCD) with similar clinical features of nephrotic syndrome (NS) and to develop a diagnostic model.

Methods

Serum samples were obtained from patients with biopsy-proven primary FSGS (n=20) and MCD (n=66) presenting with nephrotic syndrome. Serum lipidomic profiling was performed using liquid chromatography–mass spectrometry (LC-MS). Clinical variables and lipidomic markers were integrated to construct diagnostic models, and their discriminative performance was evaluated by receiver operating characteristic (ROC) curve analysis.

Results

Patients with FSGS had a higher prevalence of hypertension and worse kidney function than the MCD group. Proteinuria and serum albumin levels were comparable between the groups. Total cholesterol and LDL cholesterol levels were higher in patients with MCD. Lipidomic analysis revealed that several LDL-4–associated lipid markers—including LDL-4 apolipoprotein B (L4AB), LDL-4 particle number (L4PN), LDL-4 cholesterol (L4CH), LDL-4 phospholipids (L4PL), and LDL-4 free cholesterol (L4FC)—were elevated in the MCD group. Incorporation of these lipidomic markers improved the diagnostic performance for differentiating FSGS from MCD. The baseline clinical model showed an AUC of 0.757, which increased to 0.860 after adding LDL-4 lipidomic markers. The combined clinical–lipidomic model including kidney function variables achieved the highest discrimination (AUC 0.877, DeLong test P=0.051). Compared with the baseline model, the combined model demonstrated significant improvements in integrated discrimination improvement (IDI, 0.225; 95% confidence interval [CI], 0.117–0.336; P<0.001) and net reclassification improvement (NRI, 98.5%; 95% CI, 53.0–140.9%; P<0.001).

Conclusion

Serum LDL-4–associated lipid markers were elevated in MCD and improved diagnostic discrimination between primary FSGS and MCD in nephrotic syndrome.

Acknowledgment

This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. RS-2024-00349731).

Funding

• Government Support – Non-U.S.