Establishment of a novel nomogram for the clinically diagnostic prediction of minimal change disease, −a common cause of nephrotic syndrome

Abstract

Background Minimal change disease (MCD) is one of the major causes of nephrotic syndrome (NS). A confirmed MCD diagnosis mainly depends on renal biopsy at present, which is an invasive procedure with many potential risks. The overall incidence of complications caused by renal biopsy procedures has been reported as approximately 11 and 6.6% outside and within China, respectively. Unfortunately, there is currently no noninvasive procedure or practical classification method for distinguishing MCD from other primary glomerular diseases available. Method A total of 1009 adult patients who underwent renal biopsy between January 2017 and November 2019 were enrolled in this study. Twenty-five parameters extracted from patient demographics, clinical manifestations, and laboratory test results were statistically analysed. LASSO regression analysis was further performed on these parameters. The parameters with the highest area under the curve (AUC) were selected and used to establish a logistic diagnostic prediction model. Results Of the 25 parameters, 14 parameters were significantly different (P < 0.05). MCD patients were mostly younger (36 (22, 55) vs. 41 (28.75, 53)) and male (59% vs. 52%) and had lower levels of diastolic blood pressure (DBP) (79 (71, 85.5) vs. 80 (74, 89)) and IgG (5.42 (3.17, 6.36) vs. 9.38 (6.79, 12.02)) and higher levels of IgM (1.44 (0.96, 1.88) vs. 1.03 (0.71, 1.45)) and IgE (160 (46.7, 982) vs. 47.3 (19, 126)) than those in the non-MCD group. Using the LASSO model, we established a classifier for adults based on four parameters: DBP and the serum levels of IgG, IgM, IgE. We were able to clinically classify adult patients with NS into MCD and non-MCD using this model. The validation accuracy of the logistic regression model was 0.88. A nomogram based on these four classifiers was developed for clinical use that could predict the probability of MCD in adult patients with NS. Conclusions A LASSO model can be used to distinguish MCD from other primary glomerular diseases in adult patients with NS. Combining the model and the nomogram potentially provides a novel and valuable approach for nephrologists to diagnose MCD, avoiding the complications caused by renal biopsy.

Machine learning-based diagnostic prediction of minimal change disease: model development study

“…The need for non-invasive diagnostic methods for MCD has been discussed, but studies using predictive models are limited 8, [11][12][13]32,33 . A study using logistic LASSO regression on 1009 adult nephrotic syndrome patients demonstrated the performance of AUROC 0.880, indicating the utility of predictive models for diagnosing MCD 11 . Another study on adult nephrotic syndrome patients showed high discrimination ability for MCD with an AUROC of 0.827 using two predictor variables 13 .…”

“…However, these biomarkers cannot yet be measured in general medical facilities without advanced equipment, so their clinical utility remains uncertain. Developing predictive models using clinically measurable parameters could be bene cial, but research on such models for diagnosing MCD is limited [11][12][13] . Previous studies on diagnostic predictive models have employed logistic regression.…”

Systematic Review of the Efficacy and Safety of Traditional Chinese Medicine Granules Associated with Hormone When Treating Primary Nephrotic Syndrome in Children

“…Another literature reported that hypoimmunoglobulin G (Immunoglobulin G, IgG) hyperemia is a high-risk factor for NS. And hypoIgG hyperemia in NS is also a cause of secondary infection and recurrent episodes of PNS [7]. Clinically, glucocorticoid is the first choice to treat PNS.…”

VAI TRÒ CỦA IgA, IgG và IgM HUYẾT TƯƠNG TRONG DỰ BÁO ĐÁP ỨNG ĐIỀU TRỊ Ở NGƯỜI LỚN MẮC HỘI CHỨNG THẬN HƯ NGUYÊN PHÁT

“…Liều độc tính nếu có phải lớn hơn 5000mg/kg. Theo Diener và cộng sự (1995), dược chất có liều chết trung bình LD50 trên 5000mg/kg được cho là không độc [8]. Do đó, có thể khẳng định cao chiết hạt cà phê xanh là không độc đối với cơ thể sống.…”