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. Keywords: Focal segmental glomerulosclerosis, End stage kidney disease, Pathology

Clinical Outcomes in Patients With Biopsy Proven Anticoagulant-Related Nephropathy

“…Even though the morphologic data in kidney biopsies appeared to be similar between the patients with ARN who did recover and those who did not recover from the episode of ARN, interstitial fibrosis and tubular atrophy was associated with increased serum creatinine levels at 12-month follow up for all patients, which corresponds with previously published data. 7 , 8 , 9 …”

Develop and Validate a Risk Score in Predicting Renal Failure in Focal Segmental Glomerulosclerosis

“…Previous studies reported that impaired renal function, hypertension, and large amount of proteinuria upon diagnosis [34][35][36] as well as not response to the treatments of steroid and immunosuppressive agents were associated with progressive diseases and poor renal survival in patients with FSGS [13,20,34,37,38]. In addition, progression of FSGS disease was shown to be associated with different pathological features based on the Columbia FSGS classification [19], in which collapsing FSGS had a poorer renal survival rate and much rapid progression to ESKD compared to patients with NOS and tip variant with best renal survival rate in tip variant [11,20,38,39]. However, a recent study reported no significant difference in the progression of ESKD among different pathological FSGS variants [21].…”