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

Pelletier, J. H.; Kumar, K. R.; Engen, R.; Bensimhon, A.; Varner, J. D.; Rheault, M. N.; Srivastava, T.; Straatmann, C.; Silva, C.; Davis, T. K.; Wenderfer, S. E.; Gibson, K.; Selewski, D.; Barcia, J.; Weng, P.; Licht, C.; Jawa, N.; Kallash, M.; Foreman, J. W.; Wigfall, D. R.; Chua, A. N.; Chambers, E.; Hornik, C. P.; Brewer, E. D.; Nagaraj, S. K.; Greenbaum, L. A.; Gbadegesin, R. A.

Pediatr Nephrol. 2018 Jul 10


BACKGROUND AND OBJECTIVES: Steroid-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. METHODS: Multicenter 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. RESULTS: We 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. CONCLUSIONS: Pediatric 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.

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