Kidney Outcome in Primary Focal Segmental Glomerulosclerosis (FSGS) by Using a Predictive Model

Abstract

Background: Focal segmental glomerulosclerosis (FSGS) is one of the important causes of end stage kidney disease (ESKD). We evaluated the risk factors of progression of primary FSGS to chronic kidney disease (CKD) or ESKD with a predictive model including clinical and histological predictors.Methods: 201 patients with primary FSGS (59% male, mean age: 38±15 years), were studied. Time-dependent Cox model and C statistics were used for the predictive model. Interaction and correlation between independent variables were estimated.Results: During 55±27 months of follow-up, 82 patients (41%) developed CKD (46) or ESKD (36) patients. In adjusted model, 1 unit of higher serum creatinine (SCr) at baseline (HR:1.39, 95%CI: 1.15-1.70) and 1% increase in glomeruli with segmental glomerulosclerosis (SGS) (HR: 1.03, 95% CI: 1.02-1.04) or interstitial fibrosis/tubular atrophy (IF/TA) (HR: 1.03, 95% CI: 1.01-1.05) increased the risk of CKD/ESKD. In adjusted model, higher baseline proteinuria and collapsing variant were not associated with risk of CKD/ESKD. By adding SGS and IF/TA scores to baseline SCr in the model, discrimination by C statistics was 0.83 (95%CI: 0.77-0.90). Median renal survival was 3.1 years (95% CI: 2.2-4.1 years) in patients with highest risks score (baseline eGFR<25 ml/min/1.73 m2+ IF/TA/SGS> 50%), and 8.1 years (95% CI: 7.7-8.6 years).in those with lowest score (baseline eGFR>75 ml/min/1.73 m2+ IF/TA/SGS <5%).Conclusion: In primary FSGS, higher baseline SCr, increased SGS and IF/TA, but not baseline proteinuria and collapsing pathology, were the predictors for CKD/ESKD. These findings indicated the importance of timely detection and referral in prognosis of primary FSGS.

A new index for the outcome of focal segmental glomerulosclerosis

“…The Cox multifactor correlation analysis showed that the risk of patients in the F2 group entering ESRD was 2.3 times and the GSR > 20% was 4.6 times higher than that in the F1 group, and the increased serum creatinine value at different levels was also a high-risk factor for FSGS patients to progress to ESRD. Ossareh et al also reached a consistent conclusion on 201 patients with FSGS using the model to predict the prognosis 14 .…”

“…The renal tubules are mainly responsible for recollection, excretion, and concentration functions and maintain the balance of liquids, electrolytes, and acid–bases. We studied 206 patients with FSGS; IFTA (renal tubule/interstitial score) 0/1/2:149/35/22 (72%, 17%, and 11%), and the overall distribution trend of IFTA injuries was similar to that of Ossareh 14 ; 71/24/5 (71%, 24%, and 5%). However, the renal tubule atrophy/interstitial fibrosis scores between the two groups differed significantly according to the proportion of segmental sclerotic glomeruli.…”

“…Ossareh et al also found that the IFTA was a predictor of ESRD in a predictive model designed for the prognosis of FSGS. The risk of ESRD increased 1.06 times with an increase in tubule atrophy and interstitial fibrosis 14 .…”