A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants
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A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants. / Malakasioti, Georgia; Iancu, Daniela; Milovanova, Anastasiia; Tsygin, Alexey; Horinouchi, Tomoko; Nagano, China; Nozu, Kandai; Kamei, Koichi; Fujinaga, Shuichiro; Iijima, Kazumoto; Sinha, Rajiv; Basu, Biswanath; Morello, William; Montini, Giovanni; Waters, Aoife; Boyer, Olivia; Yıldırım, Zeynep Yürük; Yel, Sibel; Dursun, İsmail; McCarthy, Hugh J; Vivarelli, Marina; Prikhodina, Larisa; Besouw, Martine T P; Chan, Eugene Yu-Hin; Huang, Wenyan; Kemper, Markus J; Loos, Sebastian; Prestidge, Chanel; Wong, William; Zlatanova, Galia; Ehren, Rasmus; Weber, Lutz; Chehade, Hassib; Hooman, Nakysa; Tkaczyk, Marcin; Stańczyk, Małgorzata; Miligkos, Michael; Tullus, Kjell; CNI in Monogenic SRNS Study Investigators.
In: KIDNEY INT, Vol. 103, No. 5, 05.2023, p. 962-972.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants
AU - Malakasioti, Georgia
AU - Iancu, Daniela
AU - Milovanova, Anastasiia
AU - Tsygin, Alexey
AU - Horinouchi, Tomoko
AU - Nagano, China
AU - Nozu, Kandai
AU - Kamei, Koichi
AU - Fujinaga, Shuichiro
AU - Iijima, Kazumoto
AU - Sinha, Rajiv
AU - Basu, Biswanath
AU - Morello, William
AU - Montini, Giovanni
AU - Waters, Aoife
AU - Boyer, Olivia
AU - Yıldırım, Zeynep Yürük
AU - Yel, Sibel
AU - Dursun, İsmail
AU - McCarthy, Hugh J
AU - Vivarelli, Marina
AU - Prikhodina, Larisa
AU - Besouw, Martine T P
AU - Chan, Eugene Yu-Hin
AU - Huang, Wenyan
AU - Kemper, Markus J
AU - Loos, Sebastian
AU - Prestidge, Chanel
AU - Wong, William
AU - Zlatanova, Galia
AU - Ehren, Rasmus
AU - Weber, Lutz
AU - Chehade, Hassib
AU - Hooman, Nakysa
AU - Tkaczyk, Marcin
AU - Stańczyk, Małgorzata
AU - Miligkos, Michael
AU - Tullus, Kjell
AU - CNI in Monogenic SRNS Study Investigators
N1 - Copyright © 2023 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
PY - 2023/5
Y1 - 2023/5
N2 - While 44-83% of children with steroid-resistant nephrotic syndrome (SRNS) without a proven genetic cause respond to treatment with a calcineurin inhibitor (CNI), current guidelines recommend against the use of immunosuppression in monogenic SRNS. This is despite existing evidence suggesting that remission with CNI treatment is possible and can improve prognosis in some cases of monogenic SRNS. Herein, our retrospective study assessed response frequency, predictors of response and kidney function outcomes among children with monogenic SRNS treated with a CNI for at least three months. Data from 203 cases (age 0-18 years) were collected from 37 pediatric nephrology centers. Variant pathogenicity was reviewed by a geneticist, and 122 patients with a pathogenic and 19 with a possible pathogenic genotype were included in the analysis. After six months of treatment and at last visit, 27.6% and 22.5% of all patients respectively, demonstrated partial or full response. Achievement of at least partial response at six months of treatment conferred a significant reduction in kidney failure risk at last follow-up compared to no response (hazard ratio [95% confidence interval] 0.25, [0.10-0.62]). Moreover, risk of kidney failure was significantly lower when only those with a follow-up longer than two years were considered (hazard ratio 0.35, [0.14-0.91]). Higher serum albumin level at CNI initiation was the only factor related to increased likelihood of significant remission at six months (odds ratio [95% confidence interval] 1.16, [1.08-1.24]). Thus, our findings justify a treatment trial with a CNI also in children with monogenic SRNS.
AB - While 44-83% of children with steroid-resistant nephrotic syndrome (SRNS) without a proven genetic cause respond to treatment with a calcineurin inhibitor (CNI), current guidelines recommend against the use of immunosuppression in monogenic SRNS. This is despite existing evidence suggesting that remission with CNI treatment is possible and can improve prognosis in some cases of monogenic SRNS. Herein, our retrospective study assessed response frequency, predictors of response and kidney function outcomes among children with monogenic SRNS treated with a CNI for at least three months. Data from 203 cases (age 0-18 years) were collected from 37 pediatric nephrology centers. Variant pathogenicity was reviewed by a geneticist, and 122 patients with a pathogenic and 19 with a possible pathogenic genotype were included in the analysis. After six months of treatment and at last visit, 27.6% and 22.5% of all patients respectively, demonstrated partial or full response. Achievement of at least partial response at six months of treatment conferred a significant reduction in kidney failure risk at last follow-up compared to no response (hazard ratio [95% confidence interval] 0.25, [0.10-0.62]). Moreover, risk of kidney failure was significantly lower when only those with a follow-up longer than two years were considered (hazard ratio 0.35, [0.14-0.91]). Higher serum albumin level at CNI initiation was the only factor related to increased likelihood of significant remission at six months (odds ratio [95% confidence interval] 1.16, [1.08-1.24]). Thus, our findings justify a treatment trial with a CNI also in children with monogenic SRNS.
U2 - 10.1016/j.kint.2023.02.022
DO - 10.1016/j.kint.2023.02.022
M3 - SCORING: Journal article
C2 - 36898413
VL - 103
SP - 962
EP - 972
JO - KIDNEY INT
JF - KIDNEY INT
SN - 0085-2538
IS - 5
ER -
