Quantifying the benefits of remission duration in focal and segmental glomerulosclerosis

被引:3
|
作者
Jauhal, Arenn [1 ]
Reich, Heather N. [1 ]
Hladunewich, Michelle [2 ]
Barua, Moumita [1 ]
Hansen, Bettina E. [3 ]
Naimark, David [2 ]
Troyanov, Stephan [4 ]
Cattran, Daniel C. [1 ]
机构
[1] Univ Toronto, Univ Hlth Network, Dept Med, Div Nephrol, Toronto, ON, Canada
[2] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Nephrol, Toronto, ON, Canada
[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[4] Univ Montreal, Dept Med, Div Nephrol, Hop Sacre Coeur Montreal, Montreal, PQ, Canada
关键词
FSGS; landmark analyses; remission; relapse; time-dependent survival analyses; SOLUBLE UROKINASE RECEPTOR; GLOMERULAR SCLEROSIS; SERUM SUPAR; CYCLOSPORINE; ADULTS; TRIAL; FSGS;
D O I
10.1093/ndt/gfac238
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background Although the clinical benefit of obtaining a remission in proteinuria in nephrotic patients with focal segmental glomerulosclerosis (FSGS) is recognized, the long-term value of maintaining it and the impact of relapses on outcome are not well described. Methods We examined the impact of remissions and relapses on either a 50% decline in kidney function or end-stage kidney disease (combined event) using time-dependent and landmark analyses in a retrospective study of all patients from the Toronto Glomerulonephritis Registry with biopsy-proven FSGS, established nephrotic-range proteinuria and at least one remission. Results In the 203 FSGS individuals with a remission, 89 never relapsed and 114 experienced at least one relapse. The first recurrence was often followed by a repeating pattern of remission and relapse. The 10-year survival from a combined event was 15% higher in those with no relapse versus those with any relapse. This smaller than anticipated difference was related to the favourable outcome in individuals whose relapses quickly remitted. Relapsers who ultimately ended in remission (n = 46) versus in relapse (n = 68) experienced a 91% and 32% 7-year event survival (P < .001), respectively. Using time-varying survival analyses that considered all periods of remission and relapse in every patient and adjusting for each period's initial estimated glomerular filtration rate, the state of relapse was associated with a 2.17 (95% confidence interval 1.32-3.58; P = .002) greater risk of experiencing a combined event even in this FSGS remission cohort. Conclusion In FSGS, unless remissions are maintained and relapses avoided, long-term renal survival remains poor. Treatment strategies addressing remission duration remain poorly defined and should be an essential question in future trials.
引用
收藏
页码:950 / 960
页数:11
相关论文
共 50 条
  • [31] PROTEINURIA IN FOCAL SEGMENTAL GLOMERULOSCLEROSIS
    BRAUN, N
    WEBER, MH
    NIEREN-UND HOCHDRUCKKRANKHEITEN, 1992, 21 (07) : 281 - 291
  • [32] Definition of 'focal segmental glomerulosclerosis'
    Howie, AJ
    NEPHROLOGY DIALYSIS TRANSPLANTATION, 1999, 14 (02) : 514 - 514
  • [33] A Case of Focal Segmental Glomerulosclerosis
    Hogan, Jonathan J.
    CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2021, 16 (08): : 1272 - 1274
  • [34] Pathogenesis of Focal Segmental Glomerulosclerosis
    Lim, Beom Jin
    Yang, Jae Won
    Do, Woo Sung
    Fogo, Agnes B.
    JOURNAL OF PATHOLOGY AND TRANSLATIONAL MEDICINE, 2016, 50 (06) : 405 - 410
  • [35] Treatment of focal segmental glomerulosclerosis
    Meyrier, A
    EXPERT OPINION ON PHARMACOTHERAPY, 2005, 6 (09) : 1539 - 1549
  • [36] A family with focal segmental glomerulosclerosis
    de la Nieta, MDS
    Arias, LF
    Alcázar, R
    de la Torre, M
    González, L
    Rivera, F
    Blanco, J
    Ferreras, I
    NEFROLOGIA, 2003, 23 (02): : 172 - 176
  • [37] Genetics of focal segmental glomerulosclerosis
    Woroniecki, Robert P.
    Kopp, Jeffrey B.
    PEDIATRIC NEPHROLOGY, 2007, 22 (05) : 638 - 644
  • [38] FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS AND HYPERTENSION
    SEILER, AJ
    MEYRIER, A
    SIMON, P
    MORELMAROGER, L
    MERY, JP
    RICHET, G
    KIDNEY INTERNATIONAL, 1980, 18 (01) : 140 - 140
  • [39] FAMILIAL FOCAL SEGMENTAL GLOMERULOSCLEROSIS
    TEJANI, A
    NICASTRI, A
    PHADKE, K
    SEN, D
    ADAMSON, O
    DUNN, I
    CALDERON, P
    INTERNATIONAL JOURNAL OF PEDIATRIC NEPHROLOGY, 1983, 4 (04): : 231 - 234
  • [40] Genetics of focal segmental glomerulosclerosis
    Robert P. Woroniecki
    Jeffrey B. Kopp
    Pediatric Nephrology, 2007, 22 : 638 - 644