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Clinical and histopathological features of acute kidney injury in adult-onset minimal change nephrotic syndrome

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Abstract

Background

Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. To predict development of AKI, as defined by the Kidney Disease Improving Global Outcomes classification, we investigated clinical and histopathological features of adult-onset MCNS patients.

Methods

A retrospective study was conducted with biopsy-proven adult-onset MCNS patients treated with corticosteroids.

Results

A total of 58 MCNS patients [49 (24–71) years old, 38 males] were diagnosed using kidney biopsy findings from 2005 to 2018 at Osaka City University Hospital, of whom 24 (41.4%) were found to be complicated with AKI. Age, urinary protein, increased body weight (difference from admission to discharge), and histopathological scores were significantly greater in patients with as compared to without AKI, while urinary protein, increased body weight, and interstitial edema score were significantly associated with AKI development [OR 1.55 (95% CI 1.04–2.31), 1.37 (95% CI 1.03–1.81), 20.7 (95% CI 1.76–243), respectively]. Of the 24 MCNS patients with AKI, 10 underwent transient hemodialysis treatment. Although histopathological features were not different, the time interval between disease onset and kidney biopsy was significantly longer for MCNS patients complicated with AKI requiring hemodialysis as compared to those for whom that was not required [32 (24–46) vs. 13 (10–23) days, p = 0.034].

Conclusion

These results indicate that urinary protein, increased body weight, and interstitial edema score are important information for predicting development of AKI in adult-onset MCNS patients.

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Acknowledgements

We thank Drs. Rino Nakaya, Minenori Ichikawa, Ayumi Shuto, Kazuma Sone, Yusuke Fukuda, Kenta Fujimoto, Ayumi Nakatani, Mari Sakura, Yujiro Okute, Hisanori Okazaki, Mio Toyokawa, Mika Sonoda, Mitsuru Ichii, Yoshiteru Ohno, Hideaki Shima, Ikue Kobayashi, Yu Tateishi, Hirokazu Okazaki, Kaori Shidara, Kaname Hirowatari, Takao Tsuchida, and Naoki Matsumoto for their assistance in collecting samples and providing patient care. We also thank Professor Masahiko Osawa, MD, PhD, of the Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, for assistance with the histopathological examinations.

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Authors and Affiliations

  1. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Kozo Nishide, Shinya Nakatani, Fumiyuki Morioka, Yuri Machiba, Hideki Uedono, Akihiro Tsuda, Masaaki Inaba & Masanori Emoto

  2. Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Katsuhito Mori, Eiji Ishimura & Masanori Emoto

  3. Department of Internal Medicine, Ohno Memorial Hospital, 1-26-10 Minamihorie, Nishi-ku, Osaka, 550-0015, Japan

    Masaaki Inaba

  4. Department of Nephrology, Meijibashi Hospital, 1-358-3 Miyakenishi, Matsubara, Osaka, 580-0045, Japan

    Eiji Ishimura

Authors
  1. Kozo Nishide
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  2. Shinya Nakatani
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  3. Katsuhito Mori
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  4. Fumiyuki Morioka
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  5. Yuri Machiba
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  6. Hideki Uedono
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  7. Akihiro Tsuda
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  8. Masaaki Inaba
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  9. Eiji Ishimura
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  10. Masanori Emoto
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Contributions

KN contributed to study concept and design, data acquisition, analyses, interpretation, and writing the manuscript. SN and EI contributed to study concept and design, analyses, interpretation, and writing the manuscript. FM, YM, HU, AT, KM, MI, and ME contributed to study concept and data interpretation. All authors have read and approved the submitted manuscript.

Corresponding author

Correspondence to Shinya Nakatani.

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Conflict of interest

None of the authors have conflicts of interests to declare in regard to this study.

Ethical approval

The Institutional Review Board of Osaka City University Graduate School of Medicine approved the use of kidney biopsy specimens and clinical data in accordance with the Declaration of Helsinki and guidelines of the Osaka City University Graduate School of Medicine (approval no. 2378).

Informed consent

Informed consent for the kidney biopsy procedure was obtained from all individual patients included in the study. An opt-out option was given, as explained in instructions posted on the website of the institution.

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Nishide, K., Nakatani, S., Mori, K. et al. Clinical and histopathological features of acute kidney injury in adult-onset minimal change nephrotic syndrome. Clin Exp Nephrol 25, 261–269 (2021). https://doi.org/10.1007/s10157-020-01992-8

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  • DOI: https://doi.org/10.1007/s10157-020-01992-8

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