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

Abstract

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.

The Renal Pathology of Obesity: Structure-Function Correlations

“…48,49 By dividing the total nephron GFR by the total number of nonsclerotic (functioning) glomeruli in both kidneys, SNGFR was estimated and several factors were identified that possibly influence the SNGFR in healthy subjects, including obesity. 50 Recently, Sasaki et al 51,52 further modified this method and established a regression equation model to estimate the kidney cortical volume by measuring kidney parenchymal volume using unenhanced CT images in human beings. Evaluation of cortical volume by this method has allowed estimation of total glomerular number per kidney in patients with kidney disease who often are not suitable candidates for image analyses using contrast media.…”

Single-Nephron GFR in Different Glomerular Basement Membrane Stages of Membranous Nephropathy

“… 18 This technical advancement enabled us to estimate the SNGFR in patients with kidney disease, for which the administration of contrast media is generally contraindicated. 19 – 21 In this study, we aimed to assess single-nephron parameters, including SNGFR and single-nephron urinary protein excretion (SNUPE), in patients with MN with different Ehrenreich and Churg (EC) stages for GBM lesions.…”

The Transition From Minimal Change Disease to Focal and Segmental Glomerulosclerosis in a Patient With Nephrotic Syndrome: a Case Report

“…MCD is the most frequent glomerulopathy leading to the NS in childhood, accounting for about 70-90%, while adult MCD accounts for 10-20% [3,4]. Most MCD patients are responsive to corticosteroids therapy.…”

“…There is still a lot of evidence that they are different manifestations of the same progressive disease [2]. MCD is the most frequent glomerulopathy leading to the NS in childhood, accounting for about 70-90%, while adult MCD accounts for 10-20% [3,4]. Most MCD patients are responsive to corticosteroids therapy.…”