title: Complete Remission in the Nephrotic Syndrome Study Network.
abstract: OBJECTIVE
  This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever).
  
  
  METHODS
  We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC) <0.3 g/g with preserved native kidney function and (2) ESRD. Continuous variables are reported as median and interquartile range (IQR; 25th, 75th percentile). Cox proportional hazards modeling was used to assess factors associated with CRever.
  
  
  RESULTS
  We enrolled 441 patients: 116 (27%) had MCD, 142 (32%) had FSGS, 66 (15%) had membranous nephropathy, and 117 (27%) had other glomerulopathy. The baseline UPC was 4.1 g/g (IQR, 1.9, 7.7) and the eGFR was 81 ml/min per 1.73 m(2) (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis.
  
  
  CONCLUSIONS
  In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. dgipson@med.umich.edu.
authors.forename: Debbie S
authors.initials: DS
authors.lastname: Gipson
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authors.forename: Jonathan P
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authors.lastname: Troost
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authors.forename: Richard A
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authors.lastname: Lafayette
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authors.forename: Michelle A
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authors.lastname: Hladunewich
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authors.forename: Howard
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authors.lastname: Trachtman
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authors.forename: Crystal A
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authors.lastname: Gadegbeku
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authors.lastname: Sedor
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authors.lastname: Holzman
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authors.lastname: Moxey-Mims
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authors.lastname: Perumal
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authors.lastname: Kaskel
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authors.lastname: Bagnasco
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authors.lastname: Hogan
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authors.forename: Gerald B
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authors.lastname: Appel
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authors.lastname: Lieske
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authors.forename: Titilayo O
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authors.lastname: Ilori
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authors.forename: Christine B
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authors.lastname: Sethna
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authors.forename: Fernando C
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authors.lastname: Fervenza
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authors.forename: Susan L
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authors.lastname: Hogan
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authors.forename: Patrick H
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authors.lastname: Nachman
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authors.forename: Avi Z
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authors.lastname: Rosenberg
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authors.forename: Larry A
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authors.lastname: Greenbaum
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authors.forename: Kevin E C
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authors.lastname: Meyers
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authors.forename: Stephen M
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authors.lastname: Hewitt
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authors.forename: Michael J
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authors.lastname: Choi
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authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Kopp
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authors.forename: Olga
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authors.lastname: Zhdanova
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authors.forename: Jeffrey B
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authors.lastname: Hodgin
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authors.forename: Duncan B
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authors.lastname: Johnstone
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authors.forename: Sharon G
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authors.lastname: Adler
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authors.forename: Carmen
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authors.lastname: Avila-Casado
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authors.forename: Alicia M
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authors.lastname: Neu
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authors.forename: Sangeeta R
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authors.lastname: Hingorani
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authors.lastname: Lemley
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authors.forename: Cynthia C
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authors.lastname: Barisoni-Thomas
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authors.forename: Alessia
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authors.lastname: Fornoni
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authors.lastname: Palmer
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authors.forename: Heather N
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authors.lastname: Mokrzycki
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authors.forename: Kamalanathan K
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authors.lastname: Sambandam
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authors.forename: Gaston E
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authors.lastname: Zilleruelo
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authors.forename: Christoph
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authors.lastname: Licht
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authors.forename: Matthew G
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authors.lastname: Sampson
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authors.forename: Peter
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authors.lastname: Song
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authors.forename: Laura H
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authors.lastname: Mariani
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authors.forename: Matthias
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authors.lastname: Kretzler
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000503:physiopathology*; D012074:Remission Induction
keywords: cohort studies; focal segmental glomerulosclerosis; glomerular filtration rate; humans; kidney biopsy; kidney failure chronic, proteinuria; membranous nephropathy; minimal change disease; nephrotic syndrome