Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria
Background: Despite extensive research on proteinuria’s impact on chronic kidney disease progression, there is no direct comparison of outcomes in biopsy-diagnosed glomerular disease (GD) patients with nephrotic syndrome (NS) or nephrotic range proteinuria (NRP). Our study addresses this gap, compar...
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MDPI AG
2024-12-01
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| author | Gabriel Ștefan Simona Stancu Adrian Zugravu Nicoleta Petre |
| author_facet | Gabriel Ștefan Simona Stancu Adrian Zugravu Nicoleta Petre |
| author_sort | Gabriel Ștefan |
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| description | Background: Despite extensive research on proteinuria’s impact on chronic kidney disease progression, there is no direct comparison of outcomes in biopsy-diagnosed glomerular disease (GD) patients with nephrotic syndrome (NS) or nephrotic range proteinuria (NRP). Our study addresses this gap, comparing long-term outcomes between NS and NRP. Methods: We conducted a retrospective study on 240 kidney biopsy-proven GD patients, tracked from 2010 to 2015 until end-stage kidney disease (ESKD), death, or the study end in January 2022. Results: The median follow-up was 8.8 years. Diagnoses were predominantly nonproliferative (53%), proliferative (25%) nephropathies, diabetic nephropathy (12%), and paraprotein diseases (10%). NS was observed in 141 (59%) patients, presenting more frequently with arterial hypertension, higher eGFR, increased proteinuria, and dyslipidemia than NRP patients. NRP patients often had proliferative GD and diabetic nephropathy; their renal chronicity score was higher. The ESKD endpoint occurred in 35% NS and 39% NRP patients (<i>p</i> 0.4). The cohort’s mean kidney survival time was 8.2 years. In a multivariate analysis, NS, lower eGFR, a higher renal chronicity score, and diabetic nephropathy were associated with ESKD. A total of 64 patients (27%) died, 73% post-kidney replacement therapy initiation, and mostly from cardiovascular disease (63%). Mortality between proteinuria forms showed no difference. The multivariate analysis found lower eGFR, a higher Charlson comorbidity score, and diabetic nephropathy associated with mortality. Conclusions: Our study found no difference in all-cause mortality between NS and NRP in glomerular diseases. However, an adjusted analysis revealed poorer kidney survival for NS patients, emphasizing the need for personalized management to improve renal prognoses. |
| format | Article |
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| institution | Kabale University |
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| series | Life |
| spelling | doaj-art-8b46c0d1aef049bd9ab9be74618c18482024-12-27T14:36:16ZengMDPI AGLife2075-17292024-12-011412167410.3390/life14121674Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range ProteinuriaGabriel Ștefan0Simona Stancu1Adrian Zugravu2Nicoleta Petre3Department of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaDepartment of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaDepartment of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaDepartment of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaBackground: Despite extensive research on proteinuria’s impact on chronic kidney disease progression, there is no direct comparison of outcomes in biopsy-diagnosed glomerular disease (GD) patients with nephrotic syndrome (NS) or nephrotic range proteinuria (NRP). Our study addresses this gap, comparing long-term outcomes between NS and NRP. Methods: We conducted a retrospective study on 240 kidney biopsy-proven GD patients, tracked from 2010 to 2015 until end-stage kidney disease (ESKD), death, or the study end in January 2022. Results: The median follow-up was 8.8 years. Diagnoses were predominantly nonproliferative (53%), proliferative (25%) nephropathies, diabetic nephropathy (12%), and paraprotein diseases (10%). NS was observed in 141 (59%) patients, presenting more frequently with arterial hypertension, higher eGFR, increased proteinuria, and dyslipidemia than NRP patients. NRP patients often had proliferative GD and diabetic nephropathy; their renal chronicity score was higher. The ESKD endpoint occurred in 35% NS and 39% NRP patients (<i>p</i> 0.4). The cohort’s mean kidney survival time was 8.2 years. In a multivariate analysis, NS, lower eGFR, a higher renal chronicity score, and diabetic nephropathy were associated with ESKD. A total of 64 patients (27%) died, 73% post-kidney replacement therapy initiation, and mostly from cardiovascular disease (63%). Mortality between proteinuria forms showed no difference. The multivariate analysis found lower eGFR, a higher Charlson comorbidity score, and diabetic nephropathy associated with mortality. Conclusions: Our study found no difference in all-cause mortality between NS and NRP in glomerular diseases. However, an adjusted analysis revealed poorer kidney survival for NS patients, emphasizing the need for personalized management to improve renal prognoses.https://www.mdpi.com/2075-1729/14/12/1674nephrotic syndromenephrotic range proteinuriaglomerular diseaseskidney biopsyend-stage kidney diseasemortality |
| spellingShingle | Gabriel Ștefan Simona Stancu Adrian Zugravu Nicoleta Petre Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria Life nephrotic syndrome nephrotic range proteinuria glomerular diseases kidney biopsy end-stage kidney disease mortality |
| title | Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria |
| title_full | Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria |
| title_fullStr | Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria |
| title_full_unstemmed | Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria |
| title_short | Comparing Long-Term Outcomes in Glomerular Disease Patients Presenting with Nephrotic Syndrome Versus Nephrotic Range Proteinuria |
| title_sort | comparing long term outcomes in glomerular disease patients presenting with nephrotic syndrome versus nephrotic range proteinuria |
| topic | nephrotic syndrome nephrotic range proteinuria glomerular diseases kidney biopsy end-stage kidney disease mortality |
| url | https://www.mdpi.com/2075-1729/14/12/1674 |
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