Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys
Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys. This retrospective study included patients older than 16 years with biopsy-proven refractory...
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| Veröffentlicht in: | Kidney international reports 2021-08, Vol.6 (8), p.2134-2143 |
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| creator | Moret, Léa Ganea, Alexandre Dao, Myriam Hummel, Aurélie Knebelman, Bertrand Subra, Jean François Noble, Johan Mariat, Christophe Jourde-Chiche, Noémie Toure, Fatouma Garrouste, Cyril Laurent, Charlotte Adeline, Lacraz Delmas, Yahsou Cez, Alexandre Fritz, Olivier Mousson, Christiane Pouteau, Lise Marie Moranne, Olivier Halimi, Jean-Michel Audard, Vincent |
| description | Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys.
This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months.
Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m2, P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00–524], P = 0.026), age ≥50 years (OR: 22.6 [1.00–524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15–73.2], P = 0.041), and a short ( |
| doi_str_mv | 10.1016/j.ekir.2021.04.029 |
| format | Article |
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This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months.
Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m2, P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00–524], P = 0.026), age ≥50 years (OR: 22.6 [1.00–524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15–73.2], P = 0.041), and a short (<12 months) time between diagnosis and apheresis (OR: 10.8 [1–117], P = 0.043) were significantly associated with remission. Three of 7 patients in remission who were initially on dialysis became dialysis-free; by contrast, none of the 14 patients without remission was initially on dialysis, but 5 of 14 had become dialysis-dependent (P = 0.01).
Apheresis may result in remission in adult patients with refractory INS, particularly in those at risk of renal failure, with limited sensitivity to medical treatments, if apheresis is initiated within a year of diagnosis.
[Display omitted]</description><identifier>ISSN: 2468-0249</identifier><identifier>EISSN: 2468-0249</identifier><identifier>DOI: 10.1016/j.ekir.2021.04.029</identifier><identifier>PMID: 34386662</identifier><language>eng</language><publisher>Elsevier Inc</publisher><subject>apheresis ; Clinical Research ; focal segmental glomerulosclerosis ; Human health and pathology ; Life Sciences ; minimal change nephrotic syndrome ; nephrotic syndrome ; Urology and Nephrology</subject><ispartof>Kidney international reports, 2021-08, Vol.6 (8), p.2134-2143</ispartof><rights>2021</rights><rights>Attribution - NonCommercial - NoDerivatives</rights><rights>2021 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-9ed08f4223a9d7cf3e4fd73a8f038bd23f851e49619da68a63ec8ac3d100fb1a3</citedby><cites>FETCH-LOGICAL-c466t-9ed08f4223a9d7cf3e4fd73a8f038bd23f851e49619da68a63ec8ac3d100fb1a3</cites><orcidid>0000-0003-0861-2506 ; 0000-0001-5505-1364 ; 0000-0001-5343-2550 ; 0000-0001-9315-1577 ; 0000-0002-3127-1415 ; 0000-0002-0723-7735 ; 0000-0001-5166-5617</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343786/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343786/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27902,27903,53768,53770</link.rule.ids><backlink>$$Uhttps://hal.science/hal-03630516$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Moret, Léa</creatorcontrib><creatorcontrib>Ganea, Alexandre</creatorcontrib><creatorcontrib>Dao, Myriam</creatorcontrib><creatorcontrib>Hummel, Aurélie</creatorcontrib><creatorcontrib>Knebelman, Bertrand</creatorcontrib><creatorcontrib>Subra, Jean François</creatorcontrib><creatorcontrib>Noble, Johan</creatorcontrib><creatorcontrib>Mariat, Christophe</creatorcontrib><creatorcontrib>Jourde-Chiche, Noémie</creatorcontrib><creatorcontrib>Toure, Fatouma</creatorcontrib><creatorcontrib>Garrouste, Cyril</creatorcontrib><creatorcontrib>Laurent, Charlotte</creatorcontrib><creatorcontrib>Adeline, Lacraz</creatorcontrib><creatorcontrib>Delmas, Yahsou</creatorcontrib><creatorcontrib>Cez, Alexandre</creatorcontrib><creatorcontrib>Fritz, Olivier</creatorcontrib><creatorcontrib>Mousson, Christiane</creatorcontrib><creatorcontrib>Pouteau, Lise Marie</creatorcontrib><creatorcontrib>Moranne, Olivier</creatorcontrib><creatorcontrib>Halimi, Jean-Michel</creatorcontrib><creatorcontrib>Audard, Vincent</creatorcontrib><title>Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys</title><title>Kidney international reports</title><description>Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys.
This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months.
Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m2, P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00–524], P = 0.026), age ≥50 years (OR: 22.6 [1.00–524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15–73.2], P = 0.041), and a short (<12 months) time between diagnosis and apheresis (OR: 10.8 [1–117], P = 0.043) were significantly associated with remission. Three of 7 patients in remission who were initially on dialysis became dialysis-free; by contrast, none of the 14 patients without remission was initially on dialysis, but 5 of 14 had become dialysis-dependent (P = 0.01).
Apheresis may result in remission in adult patients with refractory INS, particularly in those at risk of renal failure, with limited sensitivity to medical treatments, if apheresis is initiated within a year of diagnosis.
[Display omitted]</description><subject>apheresis</subject><subject>Clinical Research</subject><subject>focal segmental glomerulosclerosis</subject><subject>Human health and pathology</subject><subject>Life Sciences</subject><subject>minimal change nephrotic syndrome</subject><subject>nephrotic syndrome</subject><subject>Urology and Nephrology</subject><issn>2468-0249</issn><issn>2468-0249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9UU1vEzEQtRCIVqV_gJOPcMgy_ojjlRBSVBVaNSpSAXG0HHuWddisF9uJlH-Po1QVcOA0o5n33nw8Ql4zaBgw9W7T4M-QGg6cNSAb4O0zcs6l0jPgsn3-R35GLnPeAABbqHkL-iU5E1JopRQ_Jw_LqceEOWQaRrr0u6HQ76H09AG7ZF2J6UBvfYiTLX1w9B6nPsVSsy-H0ae4RRpHem9L2CO9C37EQ35FXnR2yHj5GC_It4_XX69uZqvPn26vlquZk0qVWYsedCc5F7b1C9cJlJ1fCKs7EHrtuej0nKFsFWu9VdoqgU5bJzwD6NbMigvy4aQ77dZb9A7HkuxgphS2Nh1MtMH83RlDb37EvdH1_IVWVeDtSaD_h3azXJljDYQSMGdqzyr2zeOwFH_tMBezDdnhMNgR4y4bPldMalVXr1B-groUc07YPWkzMEfvzMYcvTNH7wxIU72rpPcnEtaP7QMmk13A0aEPCV0xPob_0X8DbSShoA</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Moret, Léa</creator><creator>Ganea, Alexandre</creator><creator>Dao, Myriam</creator><creator>Hummel, Aurélie</creator><creator>Knebelman, Bertrand</creator><creator>Subra, Jean François</creator><creator>Noble, Johan</creator><creator>Mariat, Christophe</creator><creator>Jourde-Chiche, Noémie</creator><creator>Toure, Fatouma</creator><creator>Garrouste, Cyril</creator><creator>Laurent, Charlotte</creator><creator>Adeline, Lacraz</creator><creator>Delmas, Yahsou</creator><creator>Cez, Alexandre</creator><creator>Fritz, Olivier</creator><creator>Mousson, Christiane</creator><creator>Pouteau, Lise Marie</creator><creator>Moranne, Olivier</creator><creator>Halimi, Jean-Michel</creator><creator>Audard, Vincent</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0861-2506</orcidid><orcidid>https://orcid.org/0000-0001-5505-1364</orcidid><orcidid>https://orcid.org/0000-0001-5343-2550</orcidid><orcidid>https://orcid.org/0000-0001-9315-1577</orcidid><orcidid>https://orcid.org/0000-0002-3127-1415</orcidid><orcidid>https://orcid.org/0000-0002-0723-7735</orcidid><orcidid>https://orcid.org/0000-0001-5166-5617</orcidid></search><sort><creationdate>20210801</creationdate><title>Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys</title><author>Moret, Léa ; Ganea, Alexandre ; Dao, Myriam ; Hummel, Aurélie ; Knebelman, Bertrand ; Subra, Jean François ; Noble, Johan ; Mariat, Christophe ; Jourde-Chiche, Noémie ; Toure, Fatouma ; Garrouste, Cyril ; Laurent, Charlotte ; Adeline, Lacraz ; Delmas, Yahsou ; Cez, Alexandre ; Fritz, Olivier ; Mousson, Christiane ; Pouteau, Lise Marie ; Moranne, Olivier ; Halimi, Jean-Michel ; Audard, Vincent</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-9ed08f4223a9d7cf3e4fd73a8f038bd23f851e49619da68a63ec8ac3d100fb1a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>apheresis</topic><topic>Clinical Research</topic><topic>focal segmental glomerulosclerosis</topic><topic>Human health and pathology</topic><topic>Life Sciences</topic><topic>minimal change nephrotic syndrome</topic><topic>nephrotic syndrome</topic><topic>Urology and Nephrology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moret, Léa</creatorcontrib><creatorcontrib>Ganea, Alexandre</creatorcontrib><creatorcontrib>Dao, Myriam</creatorcontrib><creatorcontrib>Hummel, Aurélie</creatorcontrib><creatorcontrib>Knebelman, Bertrand</creatorcontrib><creatorcontrib>Subra, Jean François</creatorcontrib><creatorcontrib>Noble, Johan</creatorcontrib><creatorcontrib>Mariat, Christophe</creatorcontrib><creatorcontrib>Jourde-Chiche, Noémie</creatorcontrib><creatorcontrib>Toure, Fatouma</creatorcontrib><creatorcontrib>Garrouste, Cyril</creatorcontrib><creatorcontrib>Laurent, Charlotte</creatorcontrib><creatorcontrib>Adeline, Lacraz</creatorcontrib><creatorcontrib>Delmas, Yahsou</creatorcontrib><creatorcontrib>Cez, Alexandre</creatorcontrib><creatorcontrib>Fritz, Olivier</creatorcontrib><creatorcontrib>Mousson, Christiane</creatorcontrib><creatorcontrib>Pouteau, Lise Marie</creatorcontrib><creatorcontrib>Moranne, Olivier</creatorcontrib><creatorcontrib>Halimi, Jean-Michel</creatorcontrib><creatorcontrib>Audard, Vincent</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Kidney international reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moret, Léa</au><au>Ganea, Alexandre</au><au>Dao, Myriam</au><au>Hummel, Aurélie</au><au>Knebelman, Bertrand</au><au>Subra, Jean François</au><au>Noble, Johan</au><au>Mariat, Christophe</au><au>Jourde-Chiche, Noémie</au><au>Toure, Fatouma</au><au>Garrouste, Cyril</au><au>Laurent, Charlotte</au><au>Adeline, Lacraz</au><au>Delmas, Yahsou</au><au>Cez, Alexandre</au><au>Fritz, Olivier</au><au>Mousson, Christiane</au><au>Pouteau, Lise Marie</au><au>Moranne, Olivier</au><au>Halimi, Jean-Michel</au><au>Audard, Vincent</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys</atitle><jtitle>Kidney international reports</jtitle><date>2021-08-01</date><risdate>2021</risdate><volume>6</volume><issue>8</issue><spage>2134</spage><epage>2143</epage><pages>2134-2143</pages><issn>2468-0249</issn><eissn>2468-0249</eissn><abstract>Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys.
This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months.
Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m2, P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00–524], P = 0.026), age ≥50 years (OR: 22.6 [1.00–524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15–73.2], P = 0.041), and a short (<12 months) time between diagnosis and apheresis (OR: 10.8 [1–117], P = 0.043) were significantly associated with remission. Three of 7 patients in remission who were initially on dialysis became dialysis-free; by contrast, none of the 14 patients without remission was initially on dialysis, but 5 of 14 had become dialysis-dependent (P = 0.01).
Apheresis may result in remission in adult patients with refractory INS, particularly in those at risk of renal failure, with limited sensitivity to medical treatments, if apheresis is initiated within a year of diagnosis.
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| subjects | apheresis Clinical Research focal segmental glomerulosclerosis Human health and pathology Life Sciences minimal change nephrotic syndrome nephrotic syndrome Urology and Nephrology |
| title | Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys |
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