Urinary CD80 excretion is a predictor of good outcome
in children with primary nephrotic syndrome
Received: 5 July 2017 / Revised: 2 January 2018 / Accepted: 4 January 2018 / Published online: 22 March 2018
Background The level of urinary cluster of differentiation 80 (uCD80) is elevated in most children with minimal change disease
(MCD) as opposed to focal segmental glomerulosclerosis (FSGS) during the acute phase. The objective of this follow-up study
was to evaluate whether uCD80 elevation is actually associated with MCD and whether it signals better prognosis.
Methods We evaluated uCD80 levels and a series of putative progression factors in a cohort of 64 patients with nephrotic
syndrome (NS) seen between 2011 and 2016. We monitored progression of chronic kidney disease (CKD), assessed as a
glomerular filtration rate of < 90 ml/min/1.73 m
for at least 3 months. Patients were classified according to uCD80 level and
to the progression rate as calculated by Kaplan–Meier survival analysis and Cox’s regression analysis.
Results During a mean follow-up period of 4.8 ± 0.6 (range 3.5–6.0) years, 13 children (20%) evolved to at least CKD stage 2.
The 64 patients with NS and normal baseline renal function were divided into two groups based on uCD80 excretion, i.e. below
or above a defined cutoff (< or > 328.98 ng/g creatinine). The predicted response to immunosuppression therapy was 34.5 and
100% in the low- and high-uCD80 excretion, respectively (p < 0.001). Progression to CKD was 41.4 vs. 2.9% in NS patients
(p < 0.001). Using the Cox model, only uCD80 excretion (p = 0.013, relative risk 6.171) predicted progression to CKD.
Conclusions Urinary CD80 predicts progression and remission in children with NS. The use of uCD80 as a prognostic marker
facilitates the identification of high-risk patients at an early stage and may lead to better treatment selection.
Chronic kidney disease
Minimal change disease (MCD) and focal segmental
glomerulosclerosis (FSGS) are the two most common causes
of nephrotic syndrome (NS) in the pediatric population .
Most children with MCD presenting as NS often respond to
corticosteroid therapy and have a good prognosis, while pa-
tients with FSGS are resistant to corticosteroids and risk
progressing to chronic kidney disease (CKD). The relationship
between MCD and primary FSGS remains controversial.
In recent years, many studies have reported significantly
elevated levels of urinary cluster of differentiation 80
(uCD80) in patients with MCD in comparison to patients
with FSGS or other glomerular diseases [2–6]. These
observations have led to uCD80 being considered to be
a diagnostic biomarker of MCD.
A number of studies have reported that elevated uCD80 in
patients is derived from podocytes [3, 7]. However, wherever
the source of uCD80, a follow-up study is needed to confirm
that a high uCD80 level reliably predicts MCD and represents
a type of nephropathy with sensitivity to steroid therapy and
In our initial study , we collected urine samples from 37
patients with MCD and 27 patients with FSGS and determined
that uCD80 is a useful biomarker for diagnosing MCD. Based
on our results, we proposed a cutoff value of 328.98 ng/g
creatinine. We also noted that three FSGS patients with tip
lesion (Tips) and one FSGS patient with not otherwise speci-
fied (NOS) glomerular disease had relatively high uCD80
levels. If uCD80 is a good prognostic indicator, these patients
with FSGS should have a better prognosis than those with low
uCD80 levels. The hypothesis requires further study.
* Xiaorong Liu
Department of Nephrology, Beijing Children’s Hospital affiliated
with Capital Medical University, West District Nan Li Shi Lu 56th,
Beijing 100045, China
Pediatric Nephrology (2018) 33:1183–1187