Global glomerulosclerosis with nephrotic syndrome; the clinical importance of age adjustment

Musab S. Hommos, Caihong Zeng, Zhihong Liu, Jonathan P. Troost, Avi Z. Rosenberg, Matthew Palmer, Walter K. Kremers, Lynn D. Cornell, Fernando C. Fervenza, Laura Barisoni-Thomas, Andrew D. Rule

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Globally sclerotic glomeruli (GSG) occur with both normal aging and kidney disease. However, it is unknown whether any GSG or only GSG exceeding that expected for age is clinically important. To evaluate this, we identified patients with a glomerulopathy that often presents with nephrotic syndrome (focal segmental glomerulosclerosis, membranous nephropathy, or minimal change disease) in the setting of the Nephrotic Syndrome Study Network (NEPTUNE), China-Digital Kidney Pathology (DiKiP), and the Southeast Minnesota cohorts. Age-based thresholds (95th percentile) for GSG based on normotensive living kidney donors were used to classify each patient into one of three groups; no GSG, GSG normal for age, or GSG abnormal for age. The risk of end-stage renal disease or a 40% decline in glomerular filtration rate during follow-up was then compared between groups. Among the 425 patients studied, 170 had no GSG, 107 had GSG normal for age, and 148 had GSG abnormal for age. Compared to those with no GSG, the risk of kidney disease progression with GSG normal for age was similar but was significantly higher with GSG abnormal for age. This increased risk with GSG abnormal for age remained significant after adjustment for interstitial fibrosis, arteriosclerosis, age, hypertension, diabetes, body mass index, glomerulopathy type, glomerular filtration rate, and proteinuria. Thus, in patients with glomerulopathy that often presents with nephrotic syndrome, global glomerulosclerosis is clinically important only if it exceeds that expected for age.

Original languageEnglish (US)
JournalKidney International
DOIs
StateAccepted/In press - Jan 1 2017

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Nephrotic Syndrome
Kidney Diseases
Glomerular Filtration Rate
Lipoid Nephrosis
Kidney
Focal Segmental Glomerulosclerosis
Membranous Glomerulonephritis
Arteriosclerosis
Living Donors
Proteinuria
Chronic Kidney Failure
Disease Progression
China
Body Mass Index
Fibrosis
Pathology
Hypertension

Keywords

  • Age-based threshold
  • FSGS
  • Global glomerulosclerosis
  • Membranous nephropathy
  • Minimal change disease
  • Nephrotic syndrome

ASJC Scopus subject areas

  • Nephrology

Cite this

Hommos, M. S., Zeng, C., Liu, Z., Troost, J. P., Rosenberg, A. Z., Palmer, M., ... Rule, A. D. (Accepted/In press). Global glomerulosclerosis with nephrotic syndrome; the clinical importance of age adjustment. Kidney International. https://doi.org/10.1016/j.kint.2017.09.028

Global glomerulosclerosis with nephrotic syndrome; the clinical importance of age adjustment. / Hommos, Musab S.; Zeng, Caihong; Liu, Zhihong; Troost, Jonathan P.; Rosenberg, Avi Z.; Palmer, Matthew; Kremers, Walter K.; Cornell, Lynn D.; Fervenza, Fernando C.; Barisoni-Thomas, Laura; Rule, Andrew D.

In: Kidney International, 01.01.2017.

Research output: Contribution to journalArticle

Hommos, MS, Zeng, C, Liu, Z, Troost, JP, Rosenberg, AZ, Palmer, M, Kremers, WK, Cornell, LD, Fervenza, FC, Barisoni-Thomas, L & Rule, AD 2017, 'Global glomerulosclerosis with nephrotic syndrome; the clinical importance of age adjustment', Kidney International. https://doi.org/10.1016/j.kint.2017.09.028
Hommos, Musab S. ; Zeng, Caihong ; Liu, Zhihong ; Troost, Jonathan P. ; Rosenberg, Avi Z. ; Palmer, Matthew ; Kremers, Walter K. ; Cornell, Lynn D. ; Fervenza, Fernando C. ; Barisoni-Thomas, Laura ; Rule, Andrew D. / Global glomerulosclerosis with nephrotic syndrome; the clinical importance of age adjustment. In: Kidney International. 2017.
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