title: Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. We evaluated the prevalence of AKI at the onset of adult MCNS and analyzed the influence of AKI on the duration of achieving complete remission (CR).
  
  
  METHODS
  A retrospective, single-centre, dynamic cohort study was conducted with biopsy-proven, first-onset, adult MCNS patients treated with corticosteroids. Fifty-three consecutive patients diagnosed with MCNS from January 2000 to April 2014 were enrolled. Age, gender, daily urinary protein excretion, and serum creatinine levels were measured. To evaluate AKI during induction, we used the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI and judged AKI stage according to the fluctuations in serum creatinine levels during the first 4 weeks of starting corticosteroid therapy.
  
  
  RESULTS
  Twenty patients (37.7%) met the AKI criteria and all 53 patients achieved CR within 1 year. Kaplan-Meier analysis showed that the median time to CR was significantly longer in patients with AKI than in patients without AKI. Cox proportional hazard analysis showed that the hazard ratio (HR) associated with the presence of AKI for achieving CR within 4 weeks was 0.36 after adjustment for age, gender, serum albumin, daily urinary protein excretion, hypertension, administration of 25% albumin, and methylprednisolone pulse therapy. A graded association was also observed between AKI stage and HR for achieving CR.
  
  
  CONCLUSIONS
  The prevalence of AKI is high in adult patients with MCNS during induction therapy. AKI is an independent factor that delays the time to CR.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. komukai-npr@umin.org.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Komukai
authors.affiliation: Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Kaneshima
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Mamiko
authors.initials: M
authors.lastname: Takayasu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Medicine, Fujiyoshida Municipal Medical Center, Yamanashi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirose
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Ashio
authors.initials: A
authors.lastname: Yoshimura
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D012074:Remission Induction / Q000379:methods
chemical_list: D005938:Glucocorticoids; D003404:Creatinine
keywords: acute renal failure; minimal change disease; nephrotic syndrome and acute kidney injury