Complete Remission in the Nephrotic Syndrome Study Network.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gipson Debbie S, Troost Jonathan P, Lafayette Richard A, Hladunewich Michelle A, Trachtman Howard, Gadegbeku Crystal A, Sedor John R, Holzman Lawrence B, Moxey-Mims Marva M, Perumal Kalyani, Kaskel Frederick J, Nelson Peter J, Tuttle Katherine R, Bagnasco Serena M, Hogan Marie C, Dell Katherine M, Appel Gerald B, Lieske John C, Ilori Titilayo O, Sethna Christine B, Fervenza Fernando C, Hogan Susan L, Nachman Patrick H, Rosenberg Avi Z, Greenbaum Larry A, Meyers Kevin E C, Hewitt Stephen M, Choi Michael J, Kopp Jeffrey B, Zhdanova Olga, Hodgin Jeffrey B, Johnstone Duncan B, Adler Sharon G, Avila-Casado Carmen, Neu Alicia M, Hingorani Sangeeta R, Lemley Kevin V, Nast Cynthia C, Brady Tammy M, Barisoni-Thomas Laura, Fornoni Alessia, Jennette J Charles, Cattran Daniel C, Palmer Matthew B, Gibson Keisha L, Reich Heather N, Mokrzycki Michele H, Sambandam Kamalanathan K, Zilleruelo Gaston E, Licht Christoph, Sampson Matthew G, Song Peter, Mariani Laura H, Kretzler Matthias
Аннотация
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC) <0.3 g/g with preserved native kidney function and (2) ESRD. Continuous variables are reported as median and interquartile range (IQR; 25th, 75th percentile). Cox proportional hazards modeling was used to assess factors associated with CRever.
RESULTS: We enrolled 441 patients: 116 (27%) had MCD, 142 (32%) had FSGS, 66 (15%) had membranous nephropathy, and 117 (27%) had other glomerulopathy. The baseline UPC was 4.1 g/g (IQR, 1.9, 7.7) and the eGFR was 81 ml/min per 1.73 m(2) (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis.
CONCLUSIONS: In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.