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Predictors of Frequent Relapses in Adult Minimal Change Disease

摘要


BACKGROUND: Minimal change disease (MCD) is a common cause of nephrotic syndrome in children. Compared to pediatric MCD, adult-onset MCD has been studied less extensively. Factors associated with frequent relapses in adult MCD remain unclear. METHODS: Between 2003 and 2015, the clinical records of adults who had been diagnosed with biopsy-proven MCD were retrospectively reviewed. Patients with secondary MCD, were younger than 18 years at diagnosis, experienced progression to focal segmental glomerulosclerosis (FSGS), and those who followed up for less than 6 months were excluded. Clinical and pathological manifestation, initial treatment regimen, and the frequency of relapse were all analyzed. RESULTS: Among a total of 116 patients, seventy four primary adult-onset MCD patients were included. Sixty eight (91.9%) patients achieved remission after their initial treatment. Relapse of nephrotic syndrome occurred in 56 (82.3%) initial responders, whereas 12 (17.6%) patients were non-relapsers. Twenty two cases were of infrequent relapse, while 34 cases were of frequent relapse. Patients aged over 61 years experienced less frequent relapse (hazard ratio [HR]: 2.81, 95% CI: 1.28–6.15, P = 0.009). Being of age ≤ 41 was an independent predictor of frequent relapse (HR: 17.03, 95% CI: 1.03–282.18, P = 0.034). Median serum immunoglobulin-E (IgE) level (mg/dL) was higher in the frequent relapse group (418.0 vs. 132.2, P = 0.043). The receiver operating characteristic (ROC) curve analysis revealed patients with initial IgE > 475 mg/dL were associated with frequent relapse (P = 0.0261). CONCLUSION: In adult-onset MCD, patients older than 61 years had a lower possibility of relapse, while those who were younger than 41 years were more likely to become frequent relapsers. A high serum IgE level, particularly > 475 mg/dL at presentation, could be a predictor for frequent relapse.

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