Renal Survival in Patients with Collapsing Compared with Not Otherwise Specified FSGS

Laurin, Louis Philippe; Gasim, Adil; Derebail, Vimal K.; McGregor, Julie Anne G.; Kidd, Jason; Hogan, Susan L.; Poulton, Caroline J.; Detwiler, Randal K.; Jennette, J. Charles; Falk, Ronald J.; Nachman, Patrick H.

doi:10.2215/cjn.13091215

Cited by 43 publications

(36 citation statements)

References 19 publications

(21 reference statements)

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“…In pregnancy, the short-term prognosis in forms secondary to hyperfiltration may be favorable, but less is known about collapsing lesions, which usually have a poor prognosis outside of pregnancy. 13,15,25,26 We report 3 patients who developed collapsing lesions in pregnancy, in 2 cases presumably superimposed on preexisting FSGS lesions (long-lasting kidney disease was suggested by ultrasonography and kidney biopsy results) and in 1 case apparently without previous pathology. These reports, observed in 2015 to 2018, suggest that the onset of collapsing lesions should be considered in patients with FSGS who have a brisk increase in serum creatinine (Scr) level or proteinuria in pregnancy, and that these lesions can respond well to treatment.…”

Section: Introductionmentioning

confidence: 98%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.

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Section: Introductionmentioning

confidence: 98%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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“…Regarding renal outcome, collapsing lesion has been associated with worst renal outcome and more common in non-responders (23). In our study all of the seven patients with collapsing lesion 9 developed CKD/ESRD, including the two patients who ended in dialysis.…”

Section: Discussionmentioning

confidence: 47%

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

Ossareh

Yahyaei

Asgari

et al. 2019

Preprint

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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

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“…Regarding renal outcome, collapsing lesion has been associated with worst renal outcome and more common in non-responders (23). In our study all of the seven patients with collapsing lesion developed CKD/ESRD, including the two patients who ended in dialysis.…”

mentioning

confidence: 47%

Development of a clinical prediction model of chronic kidney disease in primary Focal Segmental Glomerulosclerosis

Ossareh

Yahyaei

Asgari

et al. 2020

Preprint

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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) for prediction of CKD/ESKD . 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 m 2 + 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 m 2 + IF/TA/SGS <5%). Conclusion: In primary FSGS, higher baseline SCr, increased SGS and IF/TA were the predictors for CKD/ESKD. Baseline proteinuria did not predict the risk of CKD/ESKD. Collapsing variant did not increase the risk of CKD/ESKD after adjustment for IF/TA score. These findings indicated the importance of baseline GFR and the degree of chronicity at biopsy as predictors of kidney outcome .

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Renal Survival in Patients with Collapsing Compared with Not Otherwise Specified FSGS

Cited by 43 publications

References 19 publications

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

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

Development of a clinical prediction model of chronic kidney disease in primary Focal Segmental Glomerulosclerosis

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