Adults with primary nephrotic syndrome have higher rates of end-stage kidney disease (ESKD), adverse cardiovascular outcomes, and death, a new study finds.

Of 907 cases of primary nephrotic syndrome (mean age 49 years) within the Kaiser Permanente Northern California health system, 40%, 40%, and 20% had diagnosed or suspected focal segmental glomerulosclerosis (FSGS), membranous nephropathy, and minimal change disease, respectively, as the underlying etiology.

In multivariable models, primary nephrotic syndrome was significantly associated with a 19.6-fold higher adjusted risk of ESKD compared with matched adults free of diabetes, nephrotic syndrome, and nephrotic range proteinuria, Alan Go, MD, of Kaiser Permanente of Northern California in Oakland, and colleagues reported in the Journal of the American Society of Nephrology. FSGS, membranous nephropathy, and minimal change disease were significantly associated with a 24.0-, 19.3-, and 3.4-fold increased risk of ESKD compared with the control group.

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Primary nephrotic syndrome also was associated with 3.0-, 2.6-, 2.6-, and 1.8-fold increased risks for hospitalization due to heart failure, acute coronary syndrome, venous thromboembolism (specifically deep vein thrombosis, pulmonary embolism, or renal vein thrombosis), and ischemic stroke, respectively, compared with the healthy group. The risk for death was 1.3-fold higher compared with the control group.

Dr Go’s team concluded that  “the substantial excess risk of ESKD with primary NS and particularly in those with FSGS or MN highlight the need for careful surveillance in these patients, optimizing control of risk factors for renal disease progression, and identification of novel etiology-specific therapies.” The higher risk for various cardiovascular outcomes, which did not vary by disease etiology, “reinforce the importance of systematic evaluation for and management of cardiovascular risk factors and aggressive secondary prevention in those with established cardiovascular disease.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Go A, Tan T, Chertow G, et al. Primary nephrotic syndrome and risks of end-stage kidney disease, cardiovascular events, and death: the Kaiser Permanente nephrotic syndrome study. J Am Soc Nephrol. Published online June 18, 2021. doi:10.1681/ASN.2020111583