Initial Steroid Sensitivity in Children with Steroid-Resistant Nephrotic Syndrome Predicts Post-Transplant Recurrence

Wen Y Ding, Ania Koziell, Hugh J McCarthy, Agnieszka Bierzynska, Murali K Bhagavatula, Jan A Dudley, Carol D Inward, Richard J Coward, Jane Tizard, Christopher Reid, Corinne Antignac, Olivia Boyer, Moin A Saleem

Research output: Contribution to journalArticle (Academic Journal)peer-review

92 Citations (Scopus)

Abstract

Of children with idiopathic nephrotic syndrome, 10%-20% fail to respond to steroids or develop secondary steroid resistance (termed initial steroid sensitivity) and the majority progress to transplantation. Although 30%-50% of these patients suffer disease recurrence after transplantation, with poor long-term outcome, no reliable indicator of recurrence has yet been identified. Notably, the incidence of recurrence after transplantation appears reduced in patients with steroid-resistant nephrotic syndrome (SRNS) due to monogenic disorders. We reviewed 150 transplanted patients with SRNS to identify biomarkers that consistently predict outcome of SRNS after transplantation. In all, 25 children had genetic or familial SRNS and did not experience post-transplant recurrence. We reviewed phenotypic factors, including initial steroid sensitivity, donor type, age, ethnicity, time to ESRD, and time on dialysis, in the remaining 125 children. Of these patients, 57 (45.6%) developed post-transplant recurrence; 26 of 28 (92.9%) patients with initial steroid sensitivity recurred after transplantation, whereas only 26 of 86 (30.2%) patients resistant from the outset recurred (odds ratio, 30; 95% confidence interval, 6.62 to 135.86; P
Original languageEnglish
Pages (from-to)1342-1348
Number of pages7
JournalJournal of the American Society of Nephrology
Volume25
Issue number6
DOIs
Publication statusPublished - 7 Feb 2014

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