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  • Title: [Factors predicting for renal survival in primary focal segmental glomerulosclerosis].
    Author: Roja JR, Pérez M, Hurtado A, Asato C.
    Journal: Nefrologia; 2008; 28(4):439-46. PubMed ID: 18662153.
    Abstract:
    BACKGROUND: In Peru, the incidence of primary focal segmental glomerulosclerosis (PFSGS) has considerably increased in the last decade and at the present; it is the first cause of primary glomerulonephritis in adults. Because of its prevalence and high probability to progress to end-stage renal disease (ESRD), we searched for factors with prognostic value for renal survival and proteinuria remission. SUBJECTS AND METHODS: Historical cohort of 44 patients. We studied clinical and histological characteristics at the time of renal biopsy and clinical condition and renal function at the end of follow-up. PRINCIPAL OUTCOMES: renal impairment (increase >or=50% of basal creatinine levels and/or ESRD), proteinuria remission (partial 0.3-3.49 g/day and complete < 0.3g/day). Kaplan-Meier's curves and Cox's Multivariate Regression were used. RESULTS: The 59% of patients were men. The 54.5% had renal failure, 53.5% nephrotic syndrome and 43.2% hypertension or high blood pressure (HBP) at renal biopsy. The frequency of histological variants was: not otherwise specified (NOS) 75%, cellular 13.6%, tip 6.8% and perihilar 4.5%. The 56.8% received steroids for 4.3 +/- 4.5 months and 32% of these patients were corticodependent. After a mean follow-up of 21.6 +/- 27.8 months, the renal function decreased in 18.2% of patients. The 37.8% and 32.4% of patients reached partial and complete proteinuria remission respectively. Treatment with steroids, antihypertensive therapy and IgM and C3 glomerular deposits were associated with a high renal survival. The treatment with steroids was the only factor that forecasted a high renal survival (hazard ratio or HR: 0.07, 0.01-0.9) and proteinuria remission (HR: 0.2, 0.04-0.9). In general, high blood pressure (HR: 6.2, 1.1-35.2), renal failure (HR: 2.9, 1.1-7.6), cellular variant and interstitial fibrosis (HR: 5.2, 1.02-26.7) were prognostic factors for not achieving proteinuria remission. CONCLUSIONS: In primary focal segmental glomerulosclerosis, treatment with steroids forecasted a high renal survival and proteinuria remission. Renal failure and interstitial fibrosis were prognostic factors for not achieving proteinuria remission.
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