Adult-onset minimal change disease: the significance of histological chronic changes for clinical presentation and outcome.
Adrenal Cortex Hormones
/ therapeutic use
Adult
Age of Onset
Aged
Atrophy
Biomarkers
/ blood
Biopsy
Chronic Disease
Creatinine
/ blood
Female
Fibrosis
Humans
Immunosuppressive Agents
/ therapeutic use
Kidney
/ drug effects
Male
Middle Aged
Nephrosis, Lipoid
/ blood
Renal Dialysis
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Acute kidney injury
Kidney survival
Minimal change disease
Nephrotic syndrome
Renal chronicity score
Journal
Clinical and experimental nephrology
ISSN: 1437-7799
Titre abrégé: Clin Exp Nephrol
Pays: Japan
ID NLM: 9709923
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
24
08
2020
accepted:
08
10
2020
pubmed:
23
10
2020
medline:
4
11
2021
entrez:
22
10
2020
Statut:
ppublish
Résumé
Data on pathologic features with prognostic utility in adults with minimal change disease (MCD) are limited. We assessed the relationship between histologic chronic changes and clinical presentation and outcomes. The consecutive records of 79 patients with MCD and minimum of 6 months follow-up were retrospectively reviewed. Kidney survival was the primary endpoint (doubling serum creatinine or dialysis initiation). Secondary endpoints were time to remission and relapse. Total chronicity score was the sum of glomerulosclerosis (0-3), interstitial fibrosis (0-3), tubular atrophy (0-3), and arteriolosclerosis (0/1). The median renal chronicity score was 1; 77% had minimal (0-1), 18% mild (2-4), and 5% moderate (5-7) chronicity. Fifty percent had a null score; they were younger, had higher eGFR, similar proteinuria, better renal survival, and lower mortality. Mean kidney survival time was 5.7 (95% CI 5.2-6.2) years; 89% reached a form of remission at a median of 8 weeks; 31% relapsed at a mean of 26 months. Chronic changes severity predicted both relapses and kidney survival, each one-point increase in score raised with 27% the risk of relapse and with 31% the risk of dialysis initiation. Acute kidney injury (AKI) was present in 42% of the patients; they had more often mesangial proliferation, interstitial inflammation, tubular atrophy, arteriosclerosis, podocyte villous hypertrophy, and higher chronicity score. Standardized grading of chronicity was a predictor of kidney survival and disease relapse and was related to AKI. Older patients with severe nephrotic syndrome and with increased chronicity score could represent a high-risk category.
Identifiants
pubmed: 33090339
doi: 10.1007/s10157-020-01985-7
pii: 10.1007/s10157-020-01985-7
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Biomarkers
0
Immunosuppressive Agents
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
240-250Références
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