Gipson Debbie S, Troost Jonathan P, Lafayette Richard A, Hladunewich Michelle A, Trachtman Howard, Gadegbeku Crystal A, Sedor John R, Holzman Lawrence B, Moxey-Mims Marva M, Perumal Kalyani, Kaskel Frederick J, Nelson Peter J, Tuttle Katherine R, Bagnasco Serena M, Hogan Marie C, Dell Katherine M, Appel Gerald B, Lieske John C, Ilori Titilayo O, Sethna Christine B, Fervenza Fernando C, Hogan Susan L, Nachman Patrick H, Rosenberg Avi Z, Greenbaum Larry A, Meyers Kevin E C, Hewitt Stephen M, Choi Michael J, Kopp Jeffrey B, Zhdanova Olga, Hodgin Jeffrey B, Johnstone Duncan B, Adler Sharon G, Avila-Casado Carmen, Neu Alicia M, Hingorani Sangeeta R, Lemley Kevin V, Nast Cynthia C, Brady Tammy M, Barisoni-Thomas Laura, Fornoni Alessia, Jennette J Charles, Cattran Daniel C, Palmer Matthew B, Gibson Keisha L, Reich Heather N, Mokrzycki Michele H, Sambandam Kamalanathan K, Zilleruelo Gaston E, Licht Christoph, Sampson Matthew G, Song Peter, Mariani Laura H, Kretzler Matthias
Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
Clin J Am Soc Nephrol. 2016 Jan 7;11(1):81-9. doi: 10.2215/CJN.02560315. Epub 2015 Dec 10.
This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC) <0.3 g/g with preserved native kidney function and (2) ESRD. Continuous variables are reported as median and interquartile range (IQR; 25th, 75th percentile). Cox proportional hazards modeling was used to assess factors associated with CRever.
We enrolled 441 patients: 116 (27%) had MCD, 142 (32%) had FSGS, 66 (15%) had membranous nephropathy, and 117 (27%) had other glomerulopathy. The baseline UPC was 4.1 g/g (IQR, 1.9, 7.7) and the eGFR was 81 ml/min per 1.73 m(2) (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis.
In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.
来自肾病综合征研究网络（NEPTUNE）的这项分析评估了接受肾活检的蛋白尿患者的表型和病理特征，并确定了与蛋白尿完全缓解（CRever）相关的频率及因素。
设计、地点、参与者及测量指标：2010年4月至2014年6月期间，我们将北美21个地点首次临床指征肾活检时蛋白尿≥0.5g/d的成人和儿童纳入一项前瞻性队列研究。NEPTUNE中心病理学家将参与者分配至微小病变病（MCD）、局灶节段性肾小球硬化（FSGS）、膜性肾病或其他肾小球病队列。该分析的结局指标为：（1）尿蛋白肌酐比（UPC）<0.3g/g且保留天然肾功能的蛋白尿完全缓解（CRever）；（2）终末期肾病（ESRD）。连续变量以中位数和四分位数间距（IQR；第25、75百分位数）报告。采用Cox比例风险模型评估与CRever相关的因素。
我们纳入了441例患者：116例（27%）患有MCD，142例（32%）患有FSGS，66例（15%）患有膜性肾病，117例（27%）患有其他肾小球病。基线UPC为4.1g/g（IQR，1.9，7.7），估算肾小球滤过率（eGFR）为81ml/（min·1.73m²）（IQR，50，105）。中位观察期为19个月（IQR，11，30）。46%的患者出现CRever，4.6%进展为ESRD。多因素分析表明，活检前蛋白尿水平较高（风险比，0.3；95%置信区间，0.2至0.5）和病理诊断（FSGS与MCD相比；风险比，0.2；95%置信区间，0.1至0.5）与CRever呈负相关。免疫抑制治疗对缓解的影响因病理诊断而异。
在NEPTUNE研究中，蛋白尿患者中其他病理类型的高频率证实了诊断性肾活检的价值。临床因素，包括活检前蛋白尿水平、病理诊断和免疫抑制，与完全缓解相关。
