TY - JOUR
T1 - Focal Segmental Glomerulosclerosis
T2 - Assessing the Risk of Relapse
AU - Toronto Glomerulonephritis Registry Group
AU - Troyanov, Stéphan
AU - Jauhal, Arenn
AU - Reich, Heather N.
AU - Hladunewich, Michelle A.
AU - Cattran, Daniel C.
AU - Ryan, N.
AU - Ling, P.
AU - Lam, P.
AU - Romano, M.
AU - Albert, S.
AU - Aslahi, R.
AU - Aujla, P.
AU - Barrese, N.
AU - Barua, M.
AU - Berall, M.
AU - Berbece, A.
AU - Bhandhal, S.
AU - Birbrager, D. R.
AU - Boll, P.
AU - Buldo, G.
AU - Cardella, C.
AU - Chan, C.
AU - Chan, P.
AU - Charest, A.
AU - Cherney, D.
AU - Chidambaram, M.
AU - Chow, S.
AU - Cole, E.
AU - Cummings, M.
AU - Donnelly, S.
AU - Dunn, A.
AU - Elfirjani, A.
AU - Fenton, S.
AU - Fong, E.
AU - Fung, J.
AU - Goldstein, J.
AU - Harel, Z.
AU - Hercz, G.
AU - Jassal, S. V.
AU - Kajbaf, S.
AU - Kamel, K.
AU - Kang, A.
AU - Karanicolas, S.
AU - Ki, V.
AU - Kim, S. J.
AU - Kim, D. H.
AU - Konvalinka, A.
AU - Kundhal, K.
AU - Langlois, V.
AU - Wei, C.
N1 - Publisher Copyright:
© 2023 International Society of Nephrology
PY - 2023/11
Y1 - 2023/11
N2 - Introduction: Kidney outcomes are improved in primary focal segmental glomerulosclerosis (FSGS) by maintaining a remission in proteinuria. However, characteristics associated with relapses are uncertain. We sought to identify these by analyzing each remission. Methods: We performed a retrospective study in patients with biopsy-proven lesions of FSGS, absent identifiable secondary cause, who had at least 1 remission from nephrotic-range proteinuria. In each patient, we identified every remission, every relapse, and their durations. Using a multilevel logistic regression to account for the clustering of multiple remissions within a patient, we tested which clinical characteristics were independently associated with relapses. Results: In 203 individuals, 312 remissions occurred, 177 with and 135 without relapse. A minority of remissions were atypical, defined by either absent hypoalbuminemia and/or no immunosuppression (IS), in contrast to the classic nephrotic syndrome that remits with IS. Atypical remission variants were just as likely to relapse as the classical presentation. Only 24% of remission events were on maintenance therapy at relapse. Independent characteristics associated with relapses were higher maximal proteinuria while nephrotic; and in remission, higher nadir proteinuria, lower serum albumin, and higher blood pressure. Using these variables, we created a tool estimating the 1-year risk of relapse ranging from 9% to 80%, well-calibrated to the observed data. Conclusion: In FSGS, relapses are frequent but predictable using independent clinical characteristics. We also provide evidence that atypical presentations remit and relapse following the same pattern as classic FSGS presentations. Treatment strategies to prolong remission duration should be addressed in future trials.
AB - Introduction: Kidney outcomes are improved in primary focal segmental glomerulosclerosis (FSGS) by maintaining a remission in proteinuria. However, characteristics associated with relapses are uncertain. We sought to identify these by analyzing each remission. Methods: We performed a retrospective study in patients with biopsy-proven lesions of FSGS, absent identifiable secondary cause, who had at least 1 remission from nephrotic-range proteinuria. In each patient, we identified every remission, every relapse, and their durations. Using a multilevel logistic regression to account for the clustering of multiple remissions within a patient, we tested which clinical characteristics were independently associated with relapses. Results: In 203 individuals, 312 remissions occurred, 177 with and 135 without relapse. A minority of remissions were atypical, defined by either absent hypoalbuminemia and/or no immunosuppression (IS), in contrast to the classic nephrotic syndrome that remits with IS. Atypical remission variants were just as likely to relapse as the classical presentation. Only 24% of remission events were on maintenance therapy at relapse. Independent characteristics associated with relapses were higher maximal proteinuria while nephrotic; and in remission, higher nadir proteinuria, lower serum albumin, and higher blood pressure. Using these variables, we created a tool estimating the 1-year risk of relapse ranging from 9% to 80%, well-calibrated to the observed data. Conclusion: In FSGS, relapses are frequent but predictable using independent clinical characteristics. We also provide evidence that atypical presentations remit and relapse following the same pattern as classic FSGS presentations. Treatment strategies to prolong remission duration should be addressed in future trials.
KW - FSGS
KW - albuminemia
KW - event-analysis
KW - immunosuppression
KW - proteinuria
KW - relapse
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U2 - 10.1016/j.ekir.2023.08.035
DO - 10.1016/j.ekir.2023.08.035
M3 - Article
C2 - 38025232
AN - SCOPUS:85172996337
SN - 2468-0249
VL - 8
SP - 2403
EP - 2415
JO - Kidney International Reports
JF - Kidney International Reports
IS - 11
ER -