Published in:
01-12-2013 | Original Article
Age and prediction of remission and relapse of proteinuria and corticosteroid-related adverse events in adult-onset minimal-change disease: a retrospective cohort study
Published in: Clinical and Experimental Nephrology | Issue 6/2013
Login to get accessAbstract
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.