Predictors of early remission of proteinuria in adult patients with minimal change disease: a retrospective cohort study
Authors: Yamamoto Ryohei , Imai Enyu , Maruyama Shoichi , Yokoyama Hitoshi , Sugiyama Hitoshi , Takeda Asami , Uchida Shunya , Tsukamoto Tatsuo , Tsuruya Kazuhiko , Akai Yasuhiro , Nitta Kosaku , Fukunaga Megumu , Hayashi Hiroki , Masutani Kosuke , Wada Takashi , Konta Tsuneo , Katafuchi Ritsuko , Nishio Saori , Goto Shunsuke , Tamai Hirofumi , Shirasaki Arimasa , Shoji Tatsuya , Nagai Kojiro , Nishino Tomoya , Yamagata Kunihiro , Kazama Junichiro J. , Hiromura Keiju , Yasuda Hideo , Mizutani Makoto , Naruse Tomohiko , Hiramatsu Takeyuki , Morozumi Kunio , Sobajima Hiroshi , Saka Yosuke , Ishimura Eiji , Ichikawa Daisuke , Shigematsu Takashi , Sofue Tadashi , Fujimoto Shouichi , Ito Takafumi , Sato Hiroshi , Narita Ichiei , Isaka Yoshitaka ,   JNSCS Investigators, Nishio Saori , Ishikawa Yasunobu , Nakazawa Daigo , Nakagaki Tasuku , Sato Toshinobu , Sato Mitsuhiro , Sanada Satoru , Sato Hiroshi , Miyazaki Mariko , Nakamichi Takashi , Yamamoto Tae , Narumi Kaori , Yamada Gen , Konta Tsuneo , Ichikawa Kazunobu , Kazama Junichiro James , Watanabe Tsuyoshi , Asahi Koichi , Kusano Yuki , Watanabe Kimio , Yamagata Kunihiro , Usui Joichi , Kaneko Shuzo , Kawamura Tetsuya , Hiromura Keiju , Maeshima Akito , Kaneko Yoriaki , Ikeuchi Hidekazu , Sakairi Toru , Nakasatomi Masao , Hasegawa Hajime , Iwashita Takatsugu , Shimizu Taisuke , Kanozawa Koichi , Ogawa Tomonari , Takayanagi Kaori , Mitarai Tetsuya , Okada Hirokazu , Inoue Tsutomu , Suzuki Hiromichi , Tomori Kouji , Nitta Kosaku , Moriyama Takahito , Ino Akemi , Sato Masayo , Uchida Shunya , Nakajima Hideaki , Homma Hitoshi , Nagura Nichito , Tamura Yoshifuru , Shibata Shigeru , Fujigaki Yoshihide , Suzuki Yusuke , Takeda Yukihiko , Osawa Isao , Hidaka Teruo , Ichikawa Daisuke , Shibagaki Yugo , Shirai Sayuri , Sakurada Tsutomu , Suzuki Tomo , Hisamichi Mikako , Narita Ichiei , Imai Naohumi , Ito Yumi , Goto Shin , Kaneko Yoshikatsu , Kaseda Rhohei , Yokoyama Hitoshi , Fujimoto Keiji , Hayashi Norifumi , Wada Takashi , Shimizu Miho , Furuichi Kengo , Sakai Norihiko , Iwata Yasunori , Toyama Tadashi , Kitajima Shinji , Kitagawa Kiyoki , Sobajima Hiroshi , Ohashi Norimi , Oshitani So , Kawashima Kiyohito , Mimura Tetsushi , Yasuda Hideo , Hishida Akira , Fujigaki Yoshihide , Tanaka Satoshi , Mori Noriko , Akahori Toshiyuki , Fujita Yutaka , Maruyama Shoichi , Tsuboi Naotake , Kosugi Tomoki , Ishimoto Takuji , Katsuno Takayuki , Kato Noritoshi , Sato Waichi , Takeda Asami , Morozumi Kunio , Ohtsuka Yasuhiro , Shinjo Hibiki , Tanaka Akihito , Hayashi Hiroki , Yuzawa Yukio , Hasegawa Midori , Inaguma Daijo , Koide Shigehisa , Takahashi Kazuo , Hiramatsu Takeyuki , Furuta Shinji , Ishikawa Hideaki , Tamai Hirofumi , Morinaga Takatoshi , Shirasaki Arimasa , Kimura Toshiki , Kato Mina , Ichida Shizunori , Endo Nobuhide , Naruse Tomohiko , Watanabe Yuzo , Saka Yosuke , Suzuki Satashi , Yamazaki Michiko , Morita Rieko , Morozumi Kunio , Morozumi Kunio , Yasuda Kaoru , Kondo Chika , Morohiro Takahiro , Sato Rho , Shirasawa Yuichi , Fujita Yoshiro , Shimizu Hideaki , Tomino Tatsuhito , Mizutani Makoto , Saka Yosuke , Nagaya Hiroshi , Yamaguchi Makoto , Tsukamoto Tatsuo , Muso Eri , Suzuki Hiroyuki , Endo Tomomi , Kakita Hiroko , Fukunaga Megumu , Shoji Tatsuya , Hayashi Terumasa , Ishimura Eiji , Tsuda Akihiro , Nakatani Shinya , Kobayashi Ikue , Ichii Mitsuru , Ochi Akinobu , Ohno Yoshiteru , Isaka Yoshitaka , Imai Enyu , Nagasawa Yasuyuki , Iwatani Hirotsugu , Yamamoto Ryohei , Namba Tomoko , Goto Shunsuke , Nishi Shinichi , Akai Yasuhiro , Samejima Ken-ichi , Matsui Masaru , Tagawa Miho , Tanabe Kaori , Tsushima Hideo , Shigematsu Takashi , Ohya Masaki , Negi Shigeo , Mima Toru , Ito Takafumi , Sugiyama Hitoshi , Tanaka Keiko , Yamanari Toshio , Kitagawa Masashi , Onishi Akifumi , Mise Koki , Kashihara Naoki , Sasaki Tamaki , Fujimoto Sohachi , Nagasu Hajime , Nagai Kojiro , Doi Toshio , Sofue Tadashi , Kiyomoto Hideyasu , Moriwaki Kumiko , Hara Taiga , Nishijima Yoko , Kushida Yoshio , Minamino Tetsuo , Terada Yoshio , Horino Taro , Taniguchi Yoshinori , Inoue Kosuke , Shimamura Yoshiko , Matsumoto Tatsuki , Tsuruya Kazuhiko , Yoshida Hisako , Haruyama Naoki , Yamada Shunsuke , Tsuchimoto Akihiro , Matsukuma Yuta , Masutani Kosuke , Abe Yasuhiro , Hamauchi Aki , Yasuno Tetsuhiko , Ito Kenji , Fukami Kei , Yano Junko , Yoshida Chika , Kurokawa Yuka , Nakamura Nao , Katafuchi Ritsuko , Nagae Hiroshi , Matsueda Shumei , Abe Kazuto , Nishino Tomoya , Uramatsu Tadashi , Obata Yoko , Fujimoto Shouichi , Sato Yuji , Kikuchi Masao , Nishizono Ryuzo , Iwakiri Takashi , Komatsu Hiroyuki 
Published: June 2022

Previous studies reported conflicting results regarding an association between serum albumin concentration and the cumulative incidence of remission of proteinuria in adult patients with minimal change disease (MCD). The present study aimed to clarify the clinical impact of serum albumin concentration and the cumulative incidence of remission and relapse of proteinuria in 108 adult patients with MCD at 40 hospitals in Japan, who were enrolled in a 5-year prospective cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study (JNSCS). The association between serum albumin concentration before initiation of immunosuppressive treatment (IST) and the cumulative incidence of remission and relapse were assessed using multivariable-adjusted Cox proportional hazards models. Remission defined as urinary protein < 0.3 g/day (or g/gCr) was observed in 104 (96.3%) patients. Of 97 patients with remission within 6 month of IST, 42 (43.3%) developed relapse defined as ≥ 1.0 g/day (or g/gCr) or dipstick urinary protein of ≥ 2+. Serum albumin concentration was significantly associated with remission (multivariable-adjusted hazard ratio [95% confidence interval] per 1.0 g/dL, 0.57 [0.37, 0.87]), along with eGFR (per 30 mL/min/1.73 m2: 1.43 [1.08, 1.90]), whereas they were not associated with relapse. A multivariable-adjusted model showed that patients with high eGFR level (≥ 60 mL/min/1.73 m2) and low albumin concentration (≤ 1.5 g/dL) achieved significantly early remission, whereas those with low eGFR (< 60 mL/min/1.73 m2) and high albumin concentration (> 1.5 g/dL) showed significantly slow remission. In conclusion, lower serum albumin concentration and higher eGFR were associated with earlier remission in MCD, but not with relapse.