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Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease

RATIONALE & OBJECTIVE: The response to corticosteroid therapy may differ among patients with minimal change disease (MCD). Previous studies have suggested that glomerular hypertrophy or low areal glomerular density in biopsy specimens, which may be related to fewer nephrons, is associated with s...

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Autores principales: Sasaki, Takaya, Tsuboi, Nobuo, Marumoto, Hirokazu, Okabayashi, Yusuke, Haruhara, Kotaro, Kanzaki, Go, Koike, Kentaro, Ogura, Makoto, Ninomiya, Toshiharu, Yokoo, Takashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568083/
https://www.ncbi.nlm.nih.gov/pubmed/33094274
http://dx.doi.org/10.1016/j.xkme.2020.05.011
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author Sasaki, Takaya
Tsuboi, Nobuo
Marumoto, Hirokazu
Okabayashi, Yusuke
Haruhara, Kotaro
Kanzaki, Go
Koike, Kentaro
Ogura, Makoto
Ninomiya, Toshiharu
Yokoo, Takashi
author_facet Sasaki, Takaya
Tsuboi, Nobuo
Marumoto, Hirokazu
Okabayashi, Yusuke
Haruhara, Kotaro
Kanzaki, Go
Koike, Kentaro
Ogura, Makoto
Ninomiya, Toshiharu
Yokoo, Takashi
author_sort Sasaki, Takaya
collection PubMed
description RATIONALE & OBJECTIVE: The response to corticosteroid therapy may differ among patients with minimal change disease (MCD). Previous studies have suggested that glomerular hypertrophy or low areal glomerular density in biopsy specimens, which may be related to fewer nephrons, is associated with such a difference. We examined the associations between nephron number and the therapeutic response to corticosteroids in patients with MCD. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 75 adult patients with a histologic diagnosis of MCD. EXPOSURE: Nephron number per kidney estimated based on the combination of unenhanced computed tomography and nonsclerotic volumetric glomerular density in kidney biopsy specimens. OUTCOMES: Complete remission and relapse following corticosteroid therapy. ANALYTICAL APPROACH: Multivariable Cox proportional hazard analyses of associations between factors, including nephron number, and outcomes. RESULTS: Mean age of patients was 45.9 years and 60.0% were men. Patients had an estimated glomerular filtration rate of 64.6 mL/min/1.73 m(2) and proteinuria of 8.7 g/d. The estimated total number of nonsclerotic glomeruli ranged from 1.07 to 18.77 ×10(5) per kidney among all patients. There were no significant differences in total amounts or selectivity of urinary protein excretion at biopsy among the tertile groups categorized by nephron number. All patients responded to corticosteroid therapy, but those with fewer nephrons had a delayed achievement of complete remission. Multivariable Cox proportional hazard analyses identified nephron number as a significant independent explanatory variable for the achievement of complete remission, with a hazard ratio of 1.10 (95% CI, 1.02-1.19)/100,000 nephrons per kidney. Nephron number in these patients was not associated with achievement of partial remission or relapse following complete remission. LIMITATION: Retrospective design and sampling bias of needle biopsy. CONCLUSIONS: A small nephron number in patients with MCD is associated with longer time to complete remission.
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spelling pubmed-75680832020-10-21 Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease Sasaki, Takaya Tsuboi, Nobuo Marumoto, Hirokazu Okabayashi, Yusuke Haruhara, Kotaro Kanzaki, Go Koike, Kentaro Ogura, Makoto Ninomiya, Toshiharu Yokoo, Takashi Kidney Med Original Research RATIONALE & OBJECTIVE: The response to corticosteroid therapy may differ among patients with minimal change disease (MCD). Previous studies have suggested that glomerular hypertrophy or low areal glomerular density in biopsy specimens, which may be related to fewer nephrons, is associated with such a difference. We examined the associations between nephron number and the therapeutic response to corticosteroids in patients with MCD. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 75 adult patients with a histologic diagnosis of MCD. EXPOSURE: Nephron number per kidney estimated based on the combination of unenhanced computed tomography and nonsclerotic volumetric glomerular density in kidney biopsy specimens. OUTCOMES: Complete remission and relapse following corticosteroid therapy. ANALYTICAL APPROACH: Multivariable Cox proportional hazard analyses of associations between factors, including nephron number, and outcomes. RESULTS: Mean age of patients was 45.9 years and 60.0% were men. Patients had an estimated glomerular filtration rate of 64.6 mL/min/1.73 m(2) and proteinuria of 8.7 g/d. The estimated total number of nonsclerotic glomeruli ranged from 1.07 to 18.77 ×10(5) per kidney among all patients. There were no significant differences in total amounts or selectivity of urinary protein excretion at biopsy among the tertile groups categorized by nephron number. All patients responded to corticosteroid therapy, but those with fewer nephrons had a delayed achievement of complete remission. Multivariable Cox proportional hazard analyses identified nephron number as a significant independent explanatory variable for the achievement of complete remission, with a hazard ratio of 1.10 (95% CI, 1.02-1.19)/100,000 nephrons per kidney. Nephron number in these patients was not associated with achievement of partial remission or relapse following complete remission. LIMITATION: Retrospective design and sampling bias of needle biopsy. CONCLUSIONS: A small nephron number in patients with MCD is associated with longer time to complete remission. Elsevier 2020-08-01 /pmc/articles/PMC7568083/ /pubmed/33094274 http://dx.doi.org/10.1016/j.xkme.2020.05.011 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Sasaki, Takaya
Tsuboi, Nobuo
Marumoto, Hirokazu
Okabayashi, Yusuke
Haruhara, Kotaro
Kanzaki, Go
Koike, Kentaro
Ogura, Makoto
Ninomiya, Toshiharu
Yokoo, Takashi
Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title_full Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title_fullStr Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title_full_unstemmed Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title_short Nephron Number and Time to Remission in Steroid-Sensitive Minimal Change Disease
title_sort nephron number and time to remission in steroid-sensitive minimal change disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568083/
https://www.ncbi.nlm.nih.gov/pubmed/33094274
http://dx.doi.org/10.1016/j.xkme.2020.05.011
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