Proteinuria predicts relapse in adolescent and adult minimal change disease

Abstract

OBJECTIVE:This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients.METHODS:We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >13 years and had minimum 1-year follow-ups.RESULTS:Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease.CONCLUSIONS:In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day.

Minimal-change disease in adolescents and adults: epidemiology and therapeutic response

“…Eighty-two per cent of the patients achieved PR or CR. This is less than that seen in other studies in a Taiwanese population (94%) [ 14 ] or in a British (92%) [ 15 ] and Brazilian study (97%) [ 12 ]. Mean duration to achieve remission was 5.3 weeks, in contrast to 13 weeks seen by Waldman et al .…”

“…Microhaematuria was seen in 13.11% of our patients which is similar to that reported by Dias et al . [ 12 ] in a Brazilian population and by Huang et al . [ 14 ] in a Taiwanese population.…”

A Higher Frequency of CD4+CXCR5+T Follicular Helper Cells in Adult Patients with Minimal Change Disease

“…In addition to careful collection of clinical manifestations the plasma laboratory tests of antinuclear antibody (ANA), anti-Sm antibody, anti-SSA, anti-SSB, antineutrophil cytoplasmic antibody (ANCA), antiphospholipid antibody, plasma complements C3 and C4, and rheumatoid factor were performed for all the patients in the study. Renal histological and immunofluorescence results were also done to rule out patients with the potential autoimmune diseases [ 4 ]. Potential patients with bacterial infection, virus infection, diabetes, hypertension, and thromboembolism were excluded.…”

“…This kind of kidney disease can self-subside and is sensitive to hormone drugs with high cure rate of almost 90%. But adult MCD relapses are frequent and may range from 62.3 to 73.1% [ 4 ].…”

Glomerular Hypertrophy Is a Risk Factor for Relapse in Minimal Change Disease Patients

“…Thus, identification of risk factors for relapse is of utmost importance when initiating treatment. Although some parameters such as increased immunoglobulin (Ig) E levels [13], age [14] and proteinuria [16] have been suggested as risk factors for relapse, results of other studies were not always consistent [10,11,14,16]. Thus, we performed the present study to identify the potential risk factors associated with relapse in adult patients with biopsy-proven MCD.…”