Acute Kidney Injury as a Predictor of Remission and Relapse in Adult Minimal Change Disease: A Cohort Study Using Time-to-Event Analysis
DOI:
https://doi.org/10.65327/kidneys.v15i2.664Keywords:
minimal change disease, acute kidney injury, remission, relapse, survival analysisAbstract
Acute kidney injury (AKI) is a common complication in adult minimal change disease (MCD), yet its influence on remission and relapse remains insufficiently characterized. This observational cohort study evaluated the association of AKI at presentation with time to complete remission and relapse in 174 adults with biopsy-proven MCD. Patients were classified according to AKI status at diagnosis. Time to complete remission and time to relapse after remission were assessed using Kaplan–Meier analysis and compared with the log-rank test, while Cox proportional hazards models were used to identify predictors of relapse. AKI was present in 40.8% of patients. All patients achieved complete remission during follow-up, with cumulative remission rates of 66.7% at 4 weeks and 87.4% at 8 weeks. Patients without AKI achieved remission more rapidly than those with AKI, with higher remission rates at 4 weeks (77.7% vs. 50.7%) and 8 weeks (92.2% vs. 80.3%), and a shorter median time to remission (24 vs. 28 days; log-rank p < 0.001). Relapse occurred in 64.9% of patients and was less frequent in the non-AKI group than in the AKI group (55.3% vs. 78.9%). Patients without AKI also experienced later relapse, with a longer median time to relapse (132 vs. 108 days; log-rank p < 0.001). In multivariable analysis, AKI remained independently associated with relapse (HR 1.65, 95% CI 1.14–2.39), whereas older age was protective and low serum albumin increased relapse risk. These findings indicate that AKI is a clinically relevant prognostic factor in adult MCD, associated with delayed remission and a higher and earlier risk of relapse.
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