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07.07.2018 | Original Article

Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings

verfasst von: Jonathan H. Pelletier, Karan R. Kumar, Rachel Engen, Adam Bensimhon, Jennifer D. Varner, Michelle N. Rheault, Tarak Srivastava, Caroline Straatmann, Cynthia Silva, T. Keefe Davis, Scott E. Wenderfer, Keisha Gibson, David Selewski, John Barcia, Patricia Weng, Christoph Licht, Natasha Jawa, Mahmoud Kallash, John W. Foreman, Delbert R. Wigfall, Annabelle N. Chua, Eileen Chambers, Christoph P. Hornik, Eileen D. Brewer, Shashi K. Nagaraj, Larry A. Greenbaum, Rasheed A. Gbadegesin

Erschienen in: Pediatric Nephrology | Ausgabe 10/2018

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Abstract

Background and objectives

Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence.

Methods

Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence.

Results

We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3–23.7) compared to FSGS predicted disease recurrence.

Conclusions

Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.

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Titel: Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings
verfasst von: Jonathan H. Pelletier
Karan R. Kumar
Rachel Engen
Adam Bensimhon
Jennifer D. Varner
Michelle N. Rheault
Tarak Srivastava
Caroline Straatmann
Cynthia Silva
T. Keefe Davis
Scott E. Wenderfer
Keisha Gibson
David Selewski
John Barcia
Patricia Weng
Christoph Licht
Natasha Jawa
Mahmoud Kallash
John W. Foreman
Delbert R. Wigfall
Annabelle N. Chua
Eileen Chambers
Christoph P. Hornik
Eileen D. Brewer
Shashi K. Nagaraj
Larry A. Greenbaum
Rasheed A. Gbadegesin
Publikationsdatum: 07.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 10/2018
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-3994-3

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Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings