The characteristics of relapse in adult-onset minimal-change nephrotic syndrome

Takei, Takashi; Koike, Minako; Suzuki, Koichi; Shirota, Satsuki; Itabashi, Mitsuyo; Ohtsubo, Shigeru; Sugiura, Hidekazu; Suzuki, Keiko; Kojima, Chiari; Takahashi, Masaki; Ino, Jun; Ogawa, Tetsuya; Uchida, Keiko; Tsuchiya, Ken; Yumura, Wako; Nitta, Kosaku

doi:10.1007/s10157-007-0484-5

Cited by 30 publications

(25 citation statements)

References 19 publications

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“…Although few patients with MCD progress to ESRD, a series of studies reported that approximately 30%-70%, most commonly 60%, of adult MCD patients experienced at least one relapse of proteinuria (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and that 50%-60% of patients with a first relapse subsequently experienced a second relapse (7)(8)(9)(10)(11)(12). Thus, clinical goals in MCD patients are early induction of remission of proteinuria and more importantly, prevention of relapse of proteinuria.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Shinzawa¹,

Yamamoto²,

Nagasawa³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown.Design, setting, participants, & measurements This multicenter retrospective cohort study included 125 adultonset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models.Results During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P,0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding.Conclusions Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change disease patients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.

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Section: Introductionmentioning

confidence: 99%

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Shinzawa¹,

Yamamoto²,

Nagasawa³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…4,8 Most studies, in fact, 5,6,8,9,18,21,22 have reported higher IgE levels in MCD patients compared to the control group. Fuke et al 6 have shown that high IgE levels in nephrotic relapse, instead of playing a direct role in pathogenesis, are in fact a result of a dysfunction of the humoral immune system.…”

Section: Discussionmentioning

confidence: 99%

“…Increased IL-13 levels have been found in children with MCD in relapse when compared with remission and control group. 6,15,[21][22][23] Although the IL-13 secreted from the T-cell was found to be directly associated with IgE, studies on IL-4 revealed different results. 18,[24][25][26][27][28] Podocytes express the CD80 receptor for IL-13 binding.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies

et al. 2015

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Background: The etiology of minimal-change disease is not fully known, it is believed to be mediated by the immune system. Minimal-change disease also reported as having association with atopy. In this study, atopy history, the levels of serum IgE, and skin prick test in children with steroid-sensitive nephrotic syndrome were investigated. Methods: A group of 30 children (mean age 7.7 ± 2.2 years, 56.6% male) diagnosed with steroid-sensitive nephrotic syndrome were included in the study. Serum immunoglobulin E levels and eosinophil counts were evaluated in children with steroid-sensitive nephrotic syndrome both in relapse and remission. Skin prick test was performed in remission. Results: Of the 30 children investigated, 11 (36.7%) had a history of atopy. The median serum total IgE levels in nephrotic children in relapse, with (445 IU/mL) and without atopy (310 IU/mL) were significantly higher than those in remission (respectively, 200 IU/mL, p ¼ 0.021, and 42 IU/mL, p ¼ 0.001). The skin prick tests for all the allergens were evaluated as negative in all the patients. Conclusion: It was thought that increased IgE may reflect the activation of immune mechanism following various stimuli rather than a direct association with atopy in children with steroid-sensitive nephrotic syndrome.

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“…Increase of the cumulative dose of prednisolone was dependent on the occurrence of relapse. In our previous study, the relapse group showed a significantly higher incidence of corticosteroid side effects, such as osteoporosis (37). The BMD at the baseline was significantly high, and the urinary NTx and serum ALP levels at the baseline tended to be high as compared with that at the 12-month observation.…”

Section: Discussionmentioning

confidence: 99%

Risedronate Therapy for the Prevention of Steroid-induced Osteoporosis in Patients with Minimal-change Nephrotic Syndrome

et al. 2010

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Background Minimal-change nephrotic syndrome (MCNS) is treated by the administration of prednisolone (PSL) at high doses. Steroid-induced osteoporosis is a serious adverse effect of this drug. Methods Patients with MCNS were randomly assigned to two groups, the risedronate (2.5 mg/day) + alfacalcidol (0.25 μg/day) group (n=20) and the alfacalcidol (0.25 μg/day)-alone group (n=20). All the patients had received PSL and the clinical characteristics were compared between the two groups at baseline and at 12 months. Results A significant decrease of the mean bone mineral density (BMD) of the lumbar spine from 0.710± 0.162 (g/cm 2 ) to 0.588±0.125 was observed in the alfacalcidol-alone group (p=0.02), while no such decrease of the bone mineral density was found in the risedronate + alfacalcidol group (0.663±0.169 at baseline and 0.626±0.129 at 12 months). No significant differences in the results of other biochemical tests performed at the baseline and at 12 months were observed between the two groups. The likelihood of development of steroid-induced osteoporosis was influenced by the cumulative dose of PSL, the mean BMD at the baseline, occurrence of disease relapse, and risedronate therapy. Conclusion Risedronate appears to be effective in preventing steroid-induced osteoporosis. It is necessary to use bisphosphonates to maintain the BMD in patients with MCNS receiving prolonged steroid therapy.

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The characteristics of relapse in adult-onset minimal-change nephrotic syndrome

Abstract: To develop effective therapeutic modalities, it is important to have a thorough understanding of the clinico-pathophysiological characteristics of MCNS patients showing relapse.

Cited by 30 publications

References 19 publications

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies

Risedronate Therapy for the Prevention of Steroid-induced Osteoporosis in Patients with Minimal-change Nephrotic Syndrome

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