Long-term Outcome of Biopsy-Proven Minimal Change Nephropathy in Chinese Adults
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AbstractBackground: Minimal change nephropathy is a common cause of primary nephrotic syndrome in adults. However, there are few studies of its clinical course, response to treatment, and long-term outcome.
Study Design: Retrospective cohort study.
Setting & Participants: 340 consecutive adult patients with nephrotic syndrome and biopsy-proven minimal change nephropathy treated in a university hospital from 1984 until 2004.
Factors: Treatment response groups: primary steroid resistance, frequent relapse (≥4 relapses within 1 year), infrequent relapse (≥1 relapse but not frequent relapse), and no relapse (reference group); disease pattern.
Outcome: Medical problems after diagnosis; patient survival; renal survival.
Results: Median time to remission was 10 (IQR, 8-12) weeks; 179 (52.6%) had no relapse, 42 (12.4%) had infrequent relapses, 86 (25.3%) were frequent relapsers or steroid dependent, and 33 (9.7%) had primary steroid resistance. After a median follow-up of 174.7 (IQR, 119.7-235.0) months, 32 patients developed end-stage renal disease and 62 died (25 after progression to end-stage renal disease). Cox regression analysis showed that age and treatment response groups were the independent predictors of patient survival. Compared to the no-relapse group, the infrequent-relapse group had significantly better patient survival (adjusted HR, 0.19; 95% CI, 0.08-0.44; P < 0.001), whereas the primary-steroid-resistance group had significantly worse patient survival (adjusted HR, 5.87; 95% CI, 1.83-18.85; P < 0.001). Renal survival was excellent except in the primary-steroid-resistance group.
Limitations: Retrospective study.
Conclusions: A substantial proportion of adult patients with minimal change nephropathy continue to have disease flares more than 10 years after the initial presentation, and medical problems after diagnosis are common.
All Author(s) ListCheuk-Chun Szeto, Fernand Mac-Moune Lai, Kai-Ming Chow, Bonnie Ching-Ha Kwan, Vickie Wai-Ki Kwong, Chi-Bon Leung, Philip Kam-Tao Li
Journal nameAmerican Journal of Kidney Diseases
Volume Number65
Issue Number5
PublisherW. B. Saunders Co., Ltd.
Place of PublicationUnited Kingdom
Pages710 - 718
LanguagesEnglish-United Kingdom
Keywordsadult onset, end-stage renal disease (ESRD), glucocorticoid, kidney biopsy, Minimal change nephropathy (MCN), nephrotic syndrome, relapse, disease flare, remission, glomerulonephritis, renal survival, steroid resistant

Last updated on 2021-13-01 at 01:18