Amount and selectivity of proteinuria may predict the treatment response in post-transplant recurrence of focal segmental glomerulosclerosis: a single-center retrospective study

Abstract

Background

Primary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation and is associated with poor graft survival. To date, few studies have investigated predictive factors for treatment responses in recurrent FSGS.

Methods

We retrospectively analyzed 16 patients who were < 16 years at the age of onset and had post-transplant recurrence of FSGS from 1993 to 2018. Patients who achieved complete remission or partial remission after initiating therapy for recurrent FSGS were defined as responders. We compared several clinical characteristics between responders and non-responders. Time to remission was also analyzed.

Results

Ten patients were responders, and six patients were non-responders. Univariate analysis showed that responders had a significantly lower amount of maximum proteinuria at the time of recurrence (P = 0.015) and more highly selective proteinuria (P = 0.013) than non-responders. The time to remission from initiation of therapy was 2 months (interquartile range 0.2–4.4). In all responders, except for one patient, remission was achieved within 6 months.

Conclusions

Therapeutic responses may be predicted by examining the amount and selectivity of proteinuria at the time of recurrence. Further studies with larger numbers of patients are clearly required to validate these findings.

Graphical abstract

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Acknowledgements

We thank Ellen Knapp, PhD, and Traci Raley, MS, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing drafts of this manuscript.

Funding

This work was supported in part by Grants-in-Aid Scientific Research (C) (JP18K07857 to MH, JP18K07830 to KM, and JP18K07029 to KI) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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HB and MH participated in design of the work, data collection, data analysis and interpretation, drafting the article, and final approval of the version to be published. KM participated in design of the work, data collection, data analysis and interpretation, drafting the article, and critical revision of the article. NK participated in design of the work, data collection, and data analysis and interpretation. YS and TY participated in data collection. KI participated in data collection and critical revision of the article. HC, YA, HI, and KT participated in design of the work and critical revision of the article. SS participated in data analysis and interpretation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Motoshi Hattori.

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This study was approved by the ethical committee of Tokyo Women’s Medical University, School of Medicine (approval number 4968).

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Ban, H., Miura, K., Kaneko, N. et al. Amount and selectivity of proteinuria may predict the treatment response in post-transplant recurrence of focal segmental glomerulosclerosis: a single-center retrospective study. Pediatr Nephrol (2021). https://doi.org/10.1007/s00467-021-04951-x

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Keywords

  • Focal segmental glomerulosclerosis
  • Post-transplant recurrence
  • Predictive factor
  • Treatment response