FP073PROGNOSTIC SIGNIFICANCE OF RENAL BIOPSY IN ADULT ONSET MINIMAL CHANGE DISEASE

This study was carried out in the nephrology unit to Rajshahi Medical College Hospital, Rajshahi during the period 2003-2005. Renal biopsy was done in one hundred adult patients with Nephrotic syndrome to evaluate the histopathological pattern. Mesangioproliferative GN was the commonest underlying cause which is found in 36 (40%) cases. MPGN is followed by minimal change disease in 22 (24.44%), membranous GN 16 (17.77%), membranoproliferative glomerulonephritis 12 (13.33%), Focal segmental glomerulosclerosis 3 (3.34%) and IgA nephropathy 1 (1.12%) cases. This is concordant with other studies. doi: 10.3329/taj.v20i2.3076 TAJ 2007; 20(2): 140-143

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A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

Obstetric Medicine ◽

10.1177/1753495x21990214 ◽

2021 ◽

pp. 1753495X2199021

Author(s):

Priyanka S Sagar ◽

Eddy Fischer ◽

Muralikrishna Gangadharan Komala ◽

Bhadran Bose

Keyword(s):

Nephrotic Syndrome ◽

Early Diagnosis ◽

Renal Biopsy ◽

Early Pregnancy ◽

Minimal Change Disease ◽

Minimal Change ◽

Risk Of Bleeding ◽

Increased Risk ◽

Prompt Diagnosis ◽

In Pregnancy

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.

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Clinical manifestations of focal segmental glomerulosclerosis in Japan from the Japan Renal Biopsy Registry: age stratification and comparison with minimal change disease

Scientific Reports ◽

10.1038/s41598-020-80931-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takaya Ozeki ◽

Shoichi Maruyama ◽

Toshiyuki Imasawa ◽

Takehiko Kawaguchi ◽

Hiroshi Kitamura ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Focal Segmental Glomerulosclerosis ◽

Clinical Diagnosis ◽

Clinical Characteristics ◽

Minimal Change Disease ◽

Multivariable Analysis ◽

Laboratory Data ◽

Minimal Change ◽

Segmental Glomerulosclerosis

AbstractFocal segmental glomerulosclerosis (FSGS) is a serious condition leading to kidney failure. We aimed to investigate the clinical characteristics of FSGS and its differences compared with minimal change disease (MCD) using cross-sectional data from the Japan Renal Biopsy Registry. In Analysis 1, primary FSGS (n = 996) were stratified by age into three groups: pediatric (< 18 years), adult (18–64 years), and elderly (≥ 65 years), and clinical characteristics were compared. Clinical diagnosis of nephrotic syndrome (NS) was given to 73.5% (97/132) of the pediatric, 41.2% (256/622) of the adult, and 65.7% (159/242) of the elderly group. In Analysis 2, primary FSGS (n = 306) and MCD (n = 1303) whose clinical diagnosis was nephrotic syndrome (NS) and laboratory data were consistent with NS, were enrolled. Logistic regression analysis was conducted to elucidate the variables which can distinguish FSGS from MCD. On multivariable analysis, higher systolic blood pressure, higher serum albumin, lower eGFR, and presence of hematuria associated with FSGS. In Japanese nationwide registry, primary FSGS patients aged 18–64 years showed lower rate of NS than those in other ages. Among primary nephrotic cases, FSGS showed distinct clinical features from MCD.

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Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

Journal of Clinical Medicine ◽

10.3390/jcm10163632 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3632

Author(s):

Sophia Lionaki ◽

Evangelos Mantios ◽

Ioanna Tsoumbou ◽

Smaragdi Marinaki ◽

George Makris ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Injury ◽

Spontaneous Remission ◽

Minimal Change ◽

Adult Onset ◽

Potential Risk Factors ◽

The Mean ◽

End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

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Development and Validation of a Discrimination Model Between Primary PLA2R-Negative Membranous Nephropathy and Minimal Change Disease Confirmed by Renal Biopsy

10.21203/rs.3.rs-108746/v1 ◽

2020 ◽

Author(s):

Feng Wu ◽

Yiding Zhang ◽

Wen Cui ◽

Yijun Dong ◽

Yingyang Geng ◽

...

Keyword(s):

Renal Biopsy ◽

Membranous Nephropathy ◽

Minimal Change Disease ◽

Multivariate Logistic Regression Analysis ◽

Test Group ◽

Minimal Change ◽

Clinical Feature ◽

Specific Marker ◽

Discrimination Model ◽

Phospholipase A2 Receptor

Abstract BackgroundMembranous nephropathy (MN) and minimal change disease (MCD) are two common causes leading to nephrotic syndrome (NS). They have similar clinical feature but different treatment strategy and prognosis. M-type phospholipase A2 receptor (PLA2R) is considered as a specific marker of membranous nephropathy. However, its sensitivity is only about 70%. Therefore, there is a lack of effective and noninvasive tools to distinguish PLA2R-negative MN and MCD patients without renal biopsy. We aim to develop a discrimination model using noninvasive parameters for distinguishing the two diseases and support immediate treatment before result of renal biopsy.MethodsA total 949 patients who were pathologically diagnosed as idiopathic MN or primary MCD in the First Affiliated Hospital of Zhengzhou University from January 2017 to August 2019 were enrolled in this study, including 805 idiopathic MN (605 PLAR2-positive MN and 200 PLA2R-negative MN) and 144 primary MCD. Based on the basic information and laboratory examination of 200 PLA2R-negative MN and 144 MCD, we used univariate and multivariate logistic regression analysis to select the relevant variables and develop the discrimination model. ROC curves and calibration curves were used to evaluate the diagnostic ability and calibration ability of the model. The decision curve was used to show the net benefit. We also tested the effectiveness of our model in all 949 patients.ResultsA novel model that included age, albumin, urea, high density lipoprotein, urea and red blood cell count was established for PLA2R-negative MN and MCD. The discrimination model has good differential capability (an AUC of 0.889 in training group and an AUC of 0.920 in test group) and calibration capability. When testing in all 949 patients, our model also showed good discrimination ability for all idiopathic MN and MCD.ConclusionWe constructed a discrimination model with high diagnostic effectiveness for PLA2R-negative MN and MCD. The model could also be used for all idiopathic MN and MCD patients.

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Development and validation of a discrimination model between primary PLA2R-negative membranous nephropathy and minimal change disease confirmed by renal biopsy

Scientific Reports ◽

10.1038/s41598-021-97517-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Feng Wu ◽

Yiding Zhang ◽

Wen Cui ◽

Yijun Dong ◽

Yingyang Geng ◽

...

Keyword(s):

Renal Biopsy ◽

Membranous Nephropathy ◽

Minimal Change Disease ◽

Treatment Strategies ◽

Test Group ◽

Minimal Change ◽

Specific Marker ◽

Discrimination Ability ◽

Discrimination Model ◽

Phospholipase A2 Receptor

AbstractMembranous nephropathy (MN) and minimal change disease (MCD) are two common causes leading to nephrotic syndrome (NS). They have similar clinical features but different treatment strategies and prognoses. M-type phospholipase A2 receptor (PLA2R) is considered as a specific marker of membranous nephropathy. However, its sensitivity is only about 70%. Therefore, there is a lack of effective and noninvasive tools to distinguish PLA2R-negative MN and MCD patients without renal biopsy. A total 949 patients who were pathologically diagnosed as idiopathic MN or MCD were enrolled in this study, including 805 idiopathic MN and 144 MCD. Based on the basic information and laboratory examination of 200 PLA2R-negative MN and 144 MCD, we used a univariate and multivariate logistic regression to select the relevant variables and develop a discrimination model. A novel model including age, albumin, urea, high density lipoprotein, C3 levels and red blood cell count was established for PLA2R-negative MN and MCD. The discrimination model has great differential capability (with an AUC of 0.904 in training group and an AUC of 0.886 in test group) and calibration capability. When testing in all 949 patients, our model also showed good discrimination ability for all idiopathic MN and MCD.

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

BMC Nephrology ◽

10.1186/s12882-020-02058-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Gaofei Yan ◽

Guanzhi Liu ◽

Xuefei Tian ◽

Lifang Tian ◽

Hao Wang ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Minimal Change Disease ◽

Clinical Manifestations ◽

Minimal Change ◽

Adult Patients ◽

Lasso Regression ◽

Glomerular Diseases ◽

Laboratory Test Results ◽

Primary Glomerular Diseases

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.

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