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Pediatric Nephrology

, Volume 33, Issue 10, pp 1773–1780 | Cite as

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

  • 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
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation

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.

Keywords

Nephrotic syndrome Transplantation Immunosuppression Lipoid Nephrosis Focal segmental glomerulosclerosis 

Notes

Funding

National Institute of Health (NIH) and National Institute of Diabetes, Digestive and Kidney Disease (NIDDK) 5R01DK098135 and 5R01DK094987 to RG. RG and JDV are recipients of the Doris Duke Clinical Research Mentorship grant award. JHP, KK, and AB are supported by the Duke Pediatric Research Scholar (DPRS) program.

Compliance with ethical standards

Each center completed a local institutional review board approval and data usage agreements with the coordinating center at Duke University. Individual centers independently performed chart review to identify eligible patients as determined by the inclusion and exclusion criteria.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

467_2018_3994_MOESM1_ESM.doc (59 kb)
ESM 1 (DOC 59 kb)

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Jonathan H. Pelletier
    • 1
  • Karan R. Kumar
    • 1
  • Rachel Engen
    • 2
  • Adam Bensimhon
    • 1
  • Jennifer D. Varner
    • 1
  • Michelle N. Rheault
    • 3
  • Tarak Srivastava
    • 4
  • Caroline Straatmann
    • 5
  • Cynthia Silva
    • 6
  • T. Keefe Davis
    • 7
  • Scott E. Wenderfer
    • 8
  • Keisha Gibson
    • 9
  • David Selewski
    • 10
  • John Barcia
    • 11
  • Patricia Weng
    • 12
  • Christoph Licht
    • 13
  • Natasha Jawa
    • 13
  • Mahmoud Kallash
    • 14
  • John W. Foreman
    • 1
  • Delbert R. Wigfall
    • 1
  • Annabelle N. Chua
    • 1
  • Eileen Chambers
    • 1
  • Christoph P. Hornik
    • 1
  • Eileen D. Brewer
    • 8
  • Shashi K. Nagaraj
    • 1
  • Larry A. Greenbaum
    • 15
  • Rasheed A. Gbadegesin
    • 1
  1. 1.Department of Pediatrics, Divisions of Nephrology and Critical CareDuke University Medical CenterDurhamUSA
  2. 2.Ann & Robert H. Lurie Children’s Hospital of Chicago, ChicagoIllinois and Children’s Hospital SeattleWashingtonUSA
  3. 3.University of Minnesota Masonic Children’s HospitalsMinneapolisUSA
  4. 4.Children’s Mercy HospitalKansas CityUSA
  5. 5.Louisiana State University Children’s HospitalLouisianaUSA
  6. 6.Connecticut Children’s Medical CenterHartfordUSA
  7. 7.St. Louis Children’s HospitalSt LouisUSA
  8. 8.Baylor College of MedicineTexas Children’s HospitalHoustonUSA
  9. 9.North Carolina Children’s HospitalChapel HillUSA
  10. 10.C.S. Mott Children’s HospitalAnn ArborUSA
  11. 11.University of Virginia Children’s HospitalVirginiaUSA
  12. 12.Mattel Children’s Hospital University of CaliforniaCaliforniaUSA
  13. 13.The Hospital for Sick ChildrenTorontoCanada
  14. 14.Nationwide Children’s HospitalColumbusUSA
  15. 15.Emory University and Children’s Healthcare of AtlantaAtlantaUSA

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