Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings.
Background and objectives: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft l...
| Publicado en: | Pediatric Nephrology Vol. 33; no. 10; pp. 1773 - 1781 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Oct2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131661165&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131661165 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0931041X EF1 jtl: Pediatric Nephrology issn: 0931041X maglogo: N pubinfo: dt: Oct2018 vid: 33 iid: 10 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 131661165 131661165 131661165 10.1007/s00467-018-3994-3 131661165 ppf: 1773 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. aug: au: Pelletier, Jonathan H. Kumar, Karan R. Engen, Rachel Bensimhon, Adam Varner, Jennifer D. Rheault, Michelle N. Srivastava, Tarak Straatmann, Caroline Silva, Cynthia Davis, T. Keefe Wenderfer, Scott E. Gibson, Keisha Selewski, David Barcia, John Weng, Patricia Licht, Christoph Jawa, Natasha Kallash, Mahmoud Foreman, John W. Wigfall, Delbert R. affil: Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, 27710, Durham, NC, USA sug: subj: Nephrotic Syndrome Surgery Kidney Transplantation Postoperative Complications Recurrence Risk Factors Glomerulosclerosis, Focal Segmental Risk Factors Nephrosis Risk Factors Biopsy Methods Immunosuppression Glomerulosclerosis, Focal Segmental Diagnosis Nephrosis Diagnosis Human Multicenter Studies Logistic Regression Allografts Multivariate Analysis Odds Ratio Confidence Intervals Kidney Failure, Chronic Surgery Nephrotic Syndrome Complications Nephrotic Syndrome Diagnosis Nephrotic Syndrome Drug Therapy Adrenal Cortex Hormones Therapeutic Use Drug Resistance Graft Survival Kidney Failure, Chronic Etiology ab: Background and objectives: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence.Methods: Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence.Results: We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence.Conclusions: Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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