• DOI:10.1007/s00467-018-3994-3
• Corpus ID: 49586650

Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings

@article{Pelletier2018RecurrenceON,
  title={Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings},
  author={Jonathan H. Pelletier and Karan R. Kumar and Rachel M. Engen and Adam Bensimhon and Jennifer D. Varner and Michelle N. Rheault and Tarak Srivastava and Caroline Straatmann and Cynthia Silva and Thomas Keefe Davis and Scott E. Wenderfer and Keisha Gibson and David T. Selewski and John P Barcia and Patricia L Weng and Christoph Licht and Natasha A. Jawa and Mahmoud Kallash and John W. Foreman and Delbert R. Wigfall and Annabelle N Chua and Eileen T Chambers and Christoph P. Hornik and Eileen D. Brewer and Shashi K. Nagaraj and Larry A. Greenbaum and Rasheed A. Gbadegesin},
  journal={Pediatric Nephrology},
  year={2018},
  volume={33},
  pages={1773-1780}
}

• Jonathan H. Pelletier, Karan R. Kumar, +24 authors R. Gbadegesin
• Published 7 July 2018
• Medicine
• Pediatric Nephrology

Background and objectivesSteroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence.MethodsMulticenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence.ResultsWe analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3–23.7) compared to FSGS predicted disease recurrence.ConclusionsPediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.