Predicting renal survival in primary focal glomerulosclerosis from the time of presentation

Abstract

For a patient with primary FGS, these models can be used to predict the risk of developing chronic renal failure at any time and the median renal survival, given the proportion of tubulointerstitial fibrosis and plasma creatinine at the time of presentation.

Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis

“…Only the extent of interstitial fibrosis has been shown to consistently predict a poor prognosis [32,40]. In our pediatric population we found only the proportion of glomeruli with global sclerosis to be a continuous variable predictive of CKD.…”

“…The presence of nephrotic-range proteinuria has been associated with a poor prognosis in primary FSGS, with 50% of patients reaching CKD over 6 to 8 years [10,31,37,41]. However, a recent study applying multivariate analysis did not demonstrate the degree of proteinuria as an independent predictor of renal survival [32]. Yoshikawa et al [28] have demonstrated a similar prognosis in pediatric patients with FSGS with and without nephrotic syndrome.…”

“…Other studies have also demonstrated that patients with creatinine >1.3 mg/dl at presentation had a significantly poorer renal survival [36,41,42]. Chitalia et al [32] investigated 111 patients (16 to 70 years at the time of renal biopsy) and showed that plasma creatinine >0.14 mmol/l was a predictor of renal failure, in both univariate and multivariate analysis. In our series, serum creatinine at baseline as well as at the time of renal biopsy was a predictor of renal survival.…”

“…Second, knowledge about the prognosis for an individual patient or subgroups of patients can be used as a guide for selecting therapeutic options. Third, the identification of the variables with most influence on the rate of progression to CKD may lead to important etiologic and pathogenic insights and allow the characterization of relevant therapeutic targets [32]. Therefore, for this subgroup of children and adolescents, alternative treatment protocols must be developed and assessed in appropriate, randomized, clinical trials.…”

“…A number of cohort studies of FSGS in children [9,12,[24][25][26][27][28][29][30] and in adults [11,[31][32][33][34][35][36] has been reported in literature. Other studies have included both children and adults in the analysis [20,[37][38][39].…”