Complete remission in the nephrotic syndrome study network

Debbie S. Gipson, Jonathan P. Troost, Richard A. Lafayette, Michelle A. Hladunewich, Howard Trachtman, Crystal A. Gadegbeku, John R. Sedor, Lawrence B. Holzman, Marva M. Moxey-Mims, Kalyani Perumal, Frederick J. Kaskel, Peter J. Nelson, Katherine R. Tuttle, Serena M. Bagnasco, Marie C. Hogan, Katherine M. Dell, Gerald B. Appel, John C. Lieske, Titilayo O. Ilori, Christine B. Sethna & 34 others Fernando C. Fervenza, Susan L. Hogan, Patrick H. Nachman, Avi Z. Rosenberg, Larry A. Greenbaum, Kevin E C Meyers, Stephen M. Hewitt, Michael J. Choi, Jeffrey B. Kopp, Olga Zhdanova, Jeffrey B. Hodgin, Duncan B. Johnstone, Sharon G. Adler, Carmen Avila-Casado, Alicia M. Neu, Sangeeta R. Hingorani, Kevin V. Lemley, Cynthia C. Nast, Tammy M. Brady, Laura Barisoni-Thomas, Alessia Fornoni, J. Charles Jennette, Daniel C. Cattran, Matthew B. Palmer, Keisha L. Gibson, Heather N. Reich, Michele H. Mokrzycki, Kamalanathan K. Sambandam, Gaston E. Zilleruelo, Christoph Licht, Matthew G. Sampson, Peter Song, Laura H. Mariani, Matthias Kretzler

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background and objectives This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever). Design, setting, participants, & measurements We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC)2 (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis. Conclusions In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number1
DOIs
StatePublished - Jan 7 2016

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Nephrotic Syndrome
Proteinuria
Pathology
Lipoid Nephrosis
Biopsy
Kidney
Confidence Intervals
Membranous Glomerulonephritis
Immunosuppressive Agents
North America
Immunosuppression
Chronic Kidney Failure
Creatinine
Cohort Studies
Multivariate Analysis
Observation
Outcome Assessment (Health Care)
Urine
Prospective Studies
Proteins

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Gipson, D. S., Troost, J. P., Lafayette, R. A., Hladunewich, M. A., Trachtman, H., Gadegbeku, C. A., ... Kretzler, M. (2016). Complete remission in the nephrotic syndrome study network. Clinical Journal of the American Society of Nephrology, 11(1), 81-89. https://doi.org/10.2215/CJN.02560315

Complete remission in the nephrotic syndrome study network. / Gipson, Debbie S.; Troost, Jonathan P.; Lafayette, Richard A.; Hladunewich, Michelle A.; Trachtman, Howard; Gadegbeku, Crystal A.; Sedor, John R.; Holzman, Lawrence B.; Moxey-Mims, Marva M.; Perumal, Kalyani; Kaskel, Frederick J.; Nelson, Peter J.; Tuttle, Katherine R.; Bagnasco, Serena M.; Hogan, Marie C.; Dell, Katherine M.; Appel, Gerald B.; Lieske, John C.; Ilori, Titilayo O.; Sethna, Christine B.; Fervenza, Fernando C.; Hogan, Susan L.; Nachman, Patrick H.; Rosenberg, Avi Z.; Greenbaum, Larry A.; Meyers, Kevin E C; Hewitt, Stephen M.; Choi, Michael J.; Kopp, Jeffrey B.; Zhdanova, Olga; Hodgin, Jeffrey B.; Johnstone, Duncan B.; Adler, Sharon G.; Avila-Casado, Carmen; Neu, Alicia M.; Hingorani, Sangeeta R.; Lemley, Kevin V.; Nast, Cynthia C.; Brady, Tammy M.; Barisoni-Thomas, Laura; Fornoni, Alessia; Jennette, J. Charles; Cattran, Daniel C.; Palmer, Matthew B.; Gibson, Keisha L.; Reich, Heather N.; Mokrzycki, Michele H.; Sambandam, Kamalanathan K.; Zilleruelo, Gaston E.; Licht, Christoph; Sampson, Matthew G.; Song, Peter; Mariani, Laura H.; Kretzler, Matthias.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 1, 07.01.2016, p. 81-89.

Research output: Contribution to journalArticle

Gipson, DS, Troost, JP, Lafayette, RA, Hladunewich, MA, Trachtman, H, Gadegbeku, CA, Sedor, JR, Holzman, LB, Moxey-Mims, MM, Perumal, K, Kaskel, FJ, Nelson, PJ, Tuttle, KR, Bagnasco, SM, Hogan, MC, Dell, KM, Appel, GB, Lieske, JC, Ilori, TO, Sethna, CB, Fervenza, FC, Hogan, SL, Nachman, PH, Rosenberg, AZ, Greenbaum, LA, Meyers, KEC, Hewitt, SM, Choi, MJ, Kopp, JB, Zhdanova, O, Hodgin, JB, Johnstone, DB, Adler, SG, Avila-Casado, C, Neu, AM, Hingorani, SR, Lemley, KV, Nast, CC, Brady, TM, Barisoni-Thomas, L, Fornoni, A, Jennette, JC, Cattran, DC, Palmer, MB, Gibson, KL, Reich, HN, Mokrzycki, MH, Sambandam, KK, Zilleruelo, GE, Licht, C, Sampson, MG, Song, P, Mariani, LH & Kretzler, M 2016, 'Complete remission in the nephrotic syndrome study network', Clinical Journal of the American Society of Nephrology, vol. 11, no. 1, pp. 81-89. https://doi.org/10.2215/CJN.02560315
Gipson DS, Troost JP, Lafayette RA, Hladunewich MA, Trachtman H, Gadegbeku CA et al. Complete remission in the nephrotic syndrome study network. Clinical Journal of the American Society of Nephrology. 2016 Jan 7;11(1):81-89. https://doi.org/10.2215/CJN.02560315
Gipson, Debbie S. ; Troost, Jonathan P. ; Lafayette, Richard A. ; Hladunewich, Michelle A. ; Trachtman, Howard ; Gadegbeku, Crystal A. ; Sedor, John R. ; Holzman, Lawrence B. ; Moxey-Mims, Marva M. ; Perumal, Kalyani ; Kaskel, Frederick J. ; Nelson, Peter J. ; Tuttle, Katherine R. ; Bagnasco, Serena M. ; Hogan, Marie C. ; Dell, Katherine M. ; Appel, Gerald B. ; Lieske, John C. ; Ilori, Titilayo O. ; Sethna, Christine B. ; Fervenza, Fernando C. ; Hogan, Susan L. ; Nachman, Patrick H. ; Rosenberg, Avi Z. ; Greenbaum, Larry A. ; Meyers, Kevin E C ; Hewitt, Stephen M. ; Choi, Michael J. ; Kopp, Jeffrey B. ; Zhdanova, Olga ; Hodgin, Jeffrey B. ; Johnstone, Duncan B. ; Adler, Sharon G. ; Avila-Casado, Carmen ; Neu, Alicia M. ; Hingorani, Sangeeta R. ; Lemley, Kevin V. ; Nast, Cynthia C. ; Brady, Tammy M. ; Barisoni-Thomas, Laura ; Fornoni, Alessia ; Jennette, J. Charles ; Cattran, Daniel C. ; Palmer, Matthew B. ; Gibson, Keisha L. ; Reich, Heather N. ; Mokrzycki, Michele H. ; Sambandam, Kamalanathan K. ; Zilleruelo, Gaston E. ; Licht, Christoph ; Sampson, Matthew G. ; Song, Peter ; Mariani, Laura H. ; Kretzler, Matthias. / Complete remission in the nephrotic syndrome study network. In: Clinical Journal of the American Society of Nephrology. 2016 ; Vol. 11, No. 1. pp. 81-89.
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abstract = "Background and objectives This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever). Design, setting, participants, & measurements We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC)2 (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46{\%} of patients, and 4.6{\%} progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95{\%} confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95{\%} confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis. Conclusions In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.",
author = "Gipson, {Debbie S.} and Troost, {Jonathan P.} and Lafayette, {Richard A.} and Hladunewich, {Michelle A.} and Howard Trachtman and Gadegbeku, {Crystal A.} and Sedor, {John R.} and Holzman, {Lawrence B.} and Moxey-Mims, {Marva M.} and Kalyani Perumal and Kaskel, {Frederick J.} and Nelson, {Peter J.} and Tuttle, {Katherine R.} and Bagnasco, {Serena M.} and Hogan, {Marie C.} and Dell, {Katherine M.} and Appel, {Gerald B.} and Lieske, {John C.} and Ilori, {Titilayo O.} and Sethna, {Christine B.} and Fervenza, {Fernando C.} and Hogan, {Susan L.} and Nachman, {Patrick H.} and Rosenberg, {Avi Z.} and Greenbaum, {Larry A.} and Meyers, {Kevin E C} and Hewitt, {Stephen M.} and Choi, {Michael J.} and Kopp, {Jeffrey B.} and Olga Zhdanova and Hodgin, {Jeffrey B.} and Johnstone, {Duncan B.} and Adler, {Sharon G.} and Carmen Avila-Casado and Neu, {Alicia M.} and Hingorani, {Sangeeta R.} and Lemley, {Kevin V.} and Nast, {Cynthia C.} and Brady, {Tammy M.} and Laura Barisoni-Thomas and Alessia Fornoni and Jennette, {J. Charles} and Cattran, {Daniel C.} and Palmer, {Matthew B.} and Gibson, {Keisha L.} and Reich, {Heather N.} and Mokrzycki, {Michele H.} and Sambandam, {Kamalanathan K.} and Zilleruelo, {Gaston E.} and Christoph Licht and Sampson, {Matthew G.} and Peter Song and Mariani, {Laura H.} and Matthias Kretzler",
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T1 - Complete remission in the nephrotic syndrome study network

AU - Gipson, Debbie S.

AU - Troost, Jonathan P.

AU - Lafayette, Richard A.

AU - Hladunewich, Michelle A.

AU - Trachtman, Howard

AU - Gadegbeku, Crystal A.

AU - Sedor, John R.

AU - Holzman, Lawrence B.

AU - Moxey-Mims, Marva M.

AU - Perumal, Kalyani

AU - Kaskel, Frederick J.

AU - Nelson, Peter J.

AU - Tuttle, Katherine R.

AU - Bagnasco, Serena M.

AU - Hogan, Marie C.

AU - Dell, Katherine M.

AU - Appel, Gerald B.

AU - Lieske, John C.

AU - Ilori, Titilayo O.

AU - Sethna, Christine B.

AU - Fervenza, Fernando C.

AU - Hogan, Susan L.

AU - Nachman, Patrick H.

AU - Rosenberg, Avi Z.

AU - Greenbaum, Larry A.

AU - Meyers, Kevin E C

AU - Hewitt, Stephen M.

AU - Choi, Michael J.

AU - Kopp, Jeffrey B.

AU - Zhdanova, Olga

AU - Hodgin, Jeffrey B.

AU - Johnstone, Duncan B.

AU - Adler, Sharon G.

AU - Avila-Casado, Carmen

AU - Neu, Alicia M.

AU - Hingorani, Sangeeta R.

AU - Lemley, Kevin V.

AU - Nast, Cynthia C.

AU - Brady, Tammy M.

AU - Barisoni-Thomas, Laura

AU - Fornoni, Alessia

AU - Jennette, J. Charles

AU - Cattran, Daniel C.

AU - Palmer, Matthew B.

AU - Gibson, Keisha L.

AU - Reich, Heather N.

AU - Mokrzycki, Michele H.

AU - Sambandam, Kamalanathan K.

AU - Zilleruelo, Gaston E.

AU - Licht, Christoph

AU - Sampson, Matthew G.

AU - Song, Peter

AU - Mariani, Laura H.

AU - Kretzler, Matthias

PY - 2016/1/7

Y1 - 2016/1/7

N2 - Background and objectives This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever). Design, setting, participants, & measurements We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC)2 (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis. Conclusions In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.

AB - Background and objectives This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever). Design, setting, participants, & measurements We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC)2 (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis. Conclusions In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.

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