Focal glomerulosclerosis in children: Correlation of histology with prognosis

Ellis, Demetrius; Kapur, Sudesh; Antonovych, Tatiana T.; Salcedo, José R.; Yunis, Eduardo J.

doi:10.1016/s0022-3476(78)81073-7

Cited by 35 publications

(23 citation statements)

References 9 publications

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“…Among predominantly white patients with FSGS, the frequency of progression to ESRD ranges from 21%-37% [3,12,13]. The frequency among our white patients falls within this range (33%), but the equivalent value (78%) for our black and Hispanic patients is much higher.…”

Section: Discussionmentioning

confidence: 60%

Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children

1991

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The North American Pediatric Registry reports that from 1987 to 1989 blacks and Hispanic children accounted for 23% of all renal transplants performed but 38% of those performed for focal segmental glomerulosclerosis (FSGS). From these data, we infer that blacks and Hispanics form a disproportionate number of FSGS patients who progress to end-stage renal disease (ESRD) compared with white children. To explore this hypothesis we assessed our single-center experience of FSGS comparing black and Hispanic with white children. Of 177 black and Hispanic children followed in our clinic for idiopathic nephrotic syndrome (NS) between 1974 and 1989, 57 were diagnosed as having FSGS (group I). The mean age at onset of NS of these group I patients was 7.3 +/- 4.6 years and the mean duration of follow-up was 8.25 +/- 4.3 years. During the same period, 13 of 65 white patients (group II) with idiopathic NS were found to have FSGS. Their mean age (7.8 +/- 4.8 years) and duration of follow-up (8.8 +/- 4.8 years) were similar. Therapeutic modalities in the two groups were also similar. Of group I patients, 78% (42/54) reached ESRD compared with 33% (4/12) of group II patients (P less than 0.01). Life table analysis showed that 50% of black and Hispanic children will reach ESRD within 3 years of FSGS.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 60%

Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children

1991

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“…Two other studies [30,31] have demonstrated a rela tive correlation between the number of involved glomer uli and prognosis in children with FSGS. One of these studies [30] emphasizes that severe tubulointerstitial changes were more frequent in patients who ultimately developed renal failure.…”

Section: Discussionmentioning

confidence: 96%

“…One of these studies [30] emphasizes that severe tubulointerstitial changes were more frequent in patients who ultimately developed renal failure.…”

Section: Discussionmentioning

confidence: 99%

Childhood Minimal Change Disease and Focal Segmental Glomerulosclerosis: A Continuous Spectrum of Disease?

Lichtig

Ben‐Izhak²,

On³

et al. 1991

Am J Nephrol

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Thirty-three children with idiopathic nephrotic syndrome who underwent kidney needle biopsy were reevaluated. The male to female ratio was 2:1, and a preponderance of North-African Jewish and Arab origin over Ashkenazi Jewish origin was noted. There was a positive correlation between the severity of glomerular changes and prognosis among the 10 cases with minimal change disease (MCD) and the 23 with focal segmental glomerulosclerosis (FSGS). On long-term follow-up (mean over 11 years) chronic renal failure developed in none of 10 MCD patients, 1 of 12 FSGS patients with mild glomerular sclerosis, 1 of 7 FSGS patients with moderate glomerular sclerosis and 3 of 4 FSGS patients with severe glomerular sclerosis. Prognosis of patients with mild glomerular sclerotic lesion on light microscopy was substantially not worse than the prognosis of patients with mild glomerular alterations only on the electron microscopic study (MCD-B). Thus, both pathologically and prognostically, there was a continuous spectrum from ‘pure’ MCD (MCD-A) to FSGS with severe glomerular sclerosis. Glomerular changes confined to the origin of the proximal tubule (‘tip’ changes) were seen only in 4 patients and did not have a distinct prognostic significance. No case of peripheral location of the slcerotic segment within the glomerulus was found in our series of FSGS, and therefore no correlation between location of segmental sclerosis and prognosis was feasible.

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“…There was no significant difference between the SRNS and non-nephrotic patients with regard to the peritoneal culture results. Peritoneal dialysis parameters were also noted, including peritoneal dialysate volumes, dextrose concentrations, clearance of urea on dialysis (expressed as a weekly Kt/V), and total peritoneal protein daily losses [9]. If an episode of peritonitis occurred, quantitation of peritoneal protein losses or of Kt/V took place at least 12 weeks after the cessation of antibiotic administration.…”

Section: Introductionmentioning

confidence: 99%

Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis

2006

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Glomerular protein permeability rises in nephrotic syndrome and may result from the effect of an unidentified "circulating factor." The effect of this "circulating factor" on the permeability of other body membranes is unknown. In this study we examine the peritoneal membrane protein permeability in patients with nephrotic syndrome on chronic-cycler peritoneal dialysis. We conducted a retrospective study of peritoneal protein losses in the dialysate effluent of 60 pediatric peritoneal dialysis patients (ages 5.1-22 years) over a 6-year period (January 1997-December 2002). Nineteen patients had steroid-resistant nephrotic syndrome (SRNS), while 41 had other non-nephrotic etiologies of renal failure. Total and normalized peritoneal protein losses are higher in SRNS than in non-nephrotic patients (12,603+/-5,403 mg/day vs 4,475+/-469 mg/day, P<0.05; 297.8+/-79.3 mg/kg per day vs 156.8+/-16.0 mg/kg per day, P<0.05; 9,614.6+/-3,253.4 mg/m(2) per day vs 4,168.3+/-367.3 mg/m(2) per day, P<0.05). The ratio of total protein in dialysate to plasma, a measure of peritoneal membrane protein permeability, was higher in SRNS patients (3.50+/-1.00% vs 0.68+/-0.06%, P<0.001). Serum albumin concentration was lower in SRNS patients (3.09+/-0.13 mg/dl vs 3.52+/-0.07 mg/dl, P<0.01). There were no differences between the two groups with regard to duration of peritoneal dialysis, dialysis prescription, numbers of peritonitis episodes, catheter replacements, or hospitalizations. In summary, these results demonstrate that peritoneal protein losses in patients with SRNS are twice as great as in those without nephrotic syndrome. These results are consistent with the systemic effect of a "circulating factor" in SRNS and underscore the importance of adequate protein intake in patients on peritoneal dialysis.

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Focal glomerulosclerosis in children: Correlation of histology with prognosis

Cited by 35 publications

References 9 publications

Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children

Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children

Childhood Minimal Change Disease and Focal Segmental Glomerulosclerosis: A Continuous Spectrum of Disease?

Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis

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