대한신장학회

논문분류	춘계학술대회 초록집
제목	Serum Lipidomic Profiles for Distinguishing Primary Focal Segmental Glomerulosclerosis from Minimal Change Disease in Patients with Nephrotic Syndrome
저자	Dazhong Li
출판정보	2026; 2026(1):
키워드	: focal segmental glomerulosclerosis, minimal change disease, nephrotic syndrome, lipidomics, LDL-4
초록	Objectives: Primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) are representative podocytopathies that often present with similar clinical features of nephrotic syndrome (NS), making differential diagnosis difficult without kidney biopsy. This study aimed to identify serum lipidomic biomarkers that could differentiate FSGS from MCD and to develop a diagnostic model. Methods: Serum samples were obtained from patients with biopsy-proven primary FSGS (n=20) and MCD (n=66) presenting with nephrotic syndrome. Serum lipidomic profiling was performed using liquid chromatography–mass spectrometry (LC-MS). Differential lipid species were identified using partial least squares discriminant analysis (PLS-DA). Clinical variables and lipidomic markers were integrated to construct diagnostic models, and their discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Patients with FSGS had a higher prevalence of hypertension and significantly worse kidney function than those with MCD. Proteinuria and serum albumin levels were comparable between the groups. Total cholesterol and LDL cholesterol levels were significantly higher in patients with MCD. Lipidomic analysis revealed that several LDL-4–associated lipid markers—including LDL-4 apolipoprotein B (L4AB), LDL-4 particle number (L4PN), LDL-4 cholesterol (L4CH), LDL-4 phospholipids (L4PL), and LDL-4 free cholesterol (L4FC)—were significantly elevated in the MCD group. Incorporation of these lipidomic markers significantly improved the diagnostic performance for differentiating FSGS and MCD. The baseline clinical model showed an AUC of 0.757, which increased to 0.860 after adding LDL-4 lipidomic markers. The combined clinical–lipidomic model including kidney function variables achieved the highest discrimination (AUC 0.877, DeLong test p=0.047). Conclusion: Serum lipidomic profiling identified multiple LDL-4–associated lipid markers that were significantly increased in patients with MCD compared with those with FSGS. A diagnostic model incorporating these lipidomic biomarkers improved disease discrimination and may provide a promising non-invasive approach for differentiating FSGS from MCD in patients with nephrotic syndrome.
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