title: Adiponectin in children and young adults with focal segmental glomerulosclerosis.
abstract: BACKGROUND
  Adiponectin is an adipokine that is elevated in kidney disease. Evidence suggests that adiponectin exerts a direct effect on the podocyte and may play a role in the pathogenesis of proteinuria. The objectives of this study were to characterize serum and urine adiponectin levels over time in patients with focal segmental glomerulosclerosis (FSGS) and to evaluate the role of baseline levels of adiponectin as a predictor of clinical remission.
  
  
  METHODS
  This was a study of 60 individuals, ages 3-38 years, with steroid-resistant FSGS enrolled in the FSGS clinical trial. Serial measurements of serum and urine adiponectin were obtained at baseline and 26 and 52 weeks.
  
  
  RESULTS
  Participants were of mean age 19.4 ± 10.2 years (50% male, 33% black). Serum adiponectin (baseline mean 14.3 ± 6.6 μg/ml) and urine adiponectin:creatinine (Uadp/cr) (baseline mean 126.8 ± 178.9 μg/ml) directly correlated with proteinuria at all time points (r = 0.37-0.81; all p < 0.05). Proteinuria, hypoalbuminemia, and hyperlipidemia were significant independent predictors of greater serum adiponectin and Uadp/cr in multivariate analysis. Lower tertiles of baseline serum adiponectin were associated with greater response to treatment at 52 weeks when adjusted for age, sex, body mass index (BMI) z score, and estimated glomerular filtration rate (eGFR) [odds ratio (OR) 0.48; 95% confidence interval (CI) 0.26-0.91, p = 0.023). For log Uadp/cr, the OR for remission was 0.43 (95% CI 0.21-0.89, p = 0.02) at 52 weeks. However, when baseline urine protein:creatinine was added to the models, the relationships were no longer significant.
  
  
  CONCLUSIONS
  Serum and urine adiponectin levels were directly associated with proteinuria and paralleled changes in proteinuria over time in children and young adults with FSGS. Although baseline adiponectin was lower in responders, response to treatment in patients with FSGS was not associated with serum and urine adiponectin levels but, rather, was related to proteinuria.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA. csethna@nshs.edu.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Sethna
authors.affiliation: Feinstein Institute for Medical Research, Manhasset, NY, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Boone
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Kwok
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jun
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Trachtman
mesh_terms: D052242:Adiponectin / Q000032:analysis / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D003907:Dexamethasone; D016572:Cyclosporine; D009173:Mycophenolic Acid
keywords: Adiponectin; Nephrotic syndrome; Pediatric; Proteinuria