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Age and prediction of remission and relapse of proteinuria and corticosteroid-related adverse events in adult-onset minimal-change disease: a retrospective cohort study

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Abstract

Background

In adult-onset minimal-change disease (MCD) the predictors of remission and relapse of proteinuria and corticosteroid-related adverse events remain unknown.

Methods

The multicenter retrospective cohort study, the STudy of Outcomes and Practice patterns of Minimal-Change Disease (STOP-MCD), included 142 adult-onset MCD patients in 5 nephrology centers in Japan. Primary outcomes were first remission of proteinuria defined by urinary protein (UP) <0.3 g/day, UP/creatinine ratio (UPCR) <0.3, and/or negative/trace by dipstick test and first relapse of proteinuria defined by UP ≥1.0 g/day, UPCR ≥1.0, and/or dipstick test ≥1+ followed by immunosuppressive therapy. Secondary outcomes were corticosteroid-related adverse events.

Results

During the median 3.6 (interquartile range, 2.0–6.9) years of the entire observational period, 136 (95.8 %) and 79 (58.1 %) patients developed at least 1 remission and 1 recurrence within a median of 15 (10–34) days and 0.90 (0.55–1.57) years, respectively. Compared with younger patients aged 15–29 years at kidney biopsy, elderly patients aged ≥60 years developed remission significantly later [hazard ratio 0.53 (95 % confidence interval 0.32–0.88)], while older patients aged ≥45 years were at a significantly lower risk of relapse [45–59 years, 0.46 (0.22–0.96); 60–83 years, 0.39 (0.21–0.74)]. However, older patients were significantly more vulnerable to severe infection, diabetes, and cataract as compared with younger patients.

Conclusion

Younger patients had a higher risk of relapse while older patients had a lower risk of relapse but a higher risk of corticosteroid-related adverse events.

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Acknowledgments

The authors thank Kakuya Niihiata, M.D., for data management.

Conflict of interest

The authors have no potential conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, 2-2-B6 Yamadaoka, Suita, 565-0871, Japan

    Maki Shinzawa, Ryohei Yamamoto, Yasuyuki Nagasawa, Hiromi Rakugi & Yoshitaka Isaka

  2. Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, 4-14-1 Toyonaka, Shibahara, Japan

    Susumu Oseto & Megumu Fukunaga

  3. Division of Nephrology, Department of Internal Medicine, Osaka Rosai Hospital, 1179-3 Nagasone-chou, Kita-ku, Sakai, Japan

    Daisuke Mori & Atsushi Yamauchi

  4. Department of Internal Medicine, Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki, Japan

    Kodo Tomida & Masaaki Izumi

  5. Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, Japan

    Terumasa Hayashi & Yoshiharu Tsubakihara

  6. Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, 2-2-B6 Yamadaoka, Suita, Japan

    Yoshiharu Tsubakihara

Authors
  1. Maki Shinzawa
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  2. Ryohei Yamamoto
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  3. Yasuyuki Nagasawa
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  4. Susumu Oseto
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  5. Daisuke Mori
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  6. Kodo Tomida
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  7. Terumasa Hayashi
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  8. Masaaki Izumi
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  9. Megumu Fukunaga
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  10. Atsushi Yamauchi
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  11. Yoshiharu Tsubakihara
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  12. Hiromi Rakugi
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  13. Yoshitaka Isaka
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Corresponding author

Correspondence to Yoshitaka Isaka.

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Shinzawa, M., Yamamoto, R., Nagasawa, Y. et al. Age and prediction of remission and relapse of proteinuria and corticosteroid-related adverse events in adult-onset minimal-change disease: a retrospective cohort study. Clin Exp Nephrol 17, 839–847 (2013). https://doi.org/10.1007/s10157-013-0793-9

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  • DOI: https://doi.org/10.1007/s10157-013-0793-9

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