Taheri Diana, Chehrei Ali, Samanianpour Pargol, Sadrarhami Shohreh, Keshteli Ammar Hassanzadeh, Shahidi Shahrzad
Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2010 Jan;15(1):14-9.
Primary focal segmental glomerulosclerosis (FSGS) is defined by the presence of proteinuria, often in nephrotic range and pathologically by segmental scars (SS). The aim of this study is to identify the possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis.
In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patients' identities or outcomes. Patients were divided based on their histopathological findings and outcomes were compared among these groups.
There were significant differences in the complete remission rate in subjects with and without mesangial hypercellularity (p < 0.05), and in patients with and without hyalinosis (p < 0.05). According to the cut off points based on ROC curve analysis for the quantitative data, there was significant difference in renal insufficiency between the patients with and without global scars more than 12% (p < 0.05). Also multiple logistic regression analysis strongly suggests the association of mesangial hypercellularity and global scar with no complete remission and progression to renal insufficiency, respectively.
In the studied patients, presence of mesangial hypercellularity and hyalinosis has been suggested as prognostic factors for lower remission rate. According to multivariate analysis, only mesangial hypercellularity and global scar were found to act as independent prognostic predictors of lower complete remission rate and progression to renal insufficiency in patients with FSGS, respectively.
原发性局灶节段性肾小球硬化（FSGS）的定义是存在蛋白尿，通常为肾病范围蛋白尿，病理表现为节段性瘢痕（SS）。本研究的目的是确定伊朗原发性局灶节段性肾小球硬化成年患者完全缓解或进展为慢性肾脏病的可能预测因素。
在这项历史性队列研究中，由一名肾脏病理学家对50例原发性FSGS患者的病理结果进行回顾，该病理学家对患者的身份或结局不知情。根据患者的组织病理学结果进行分组，并比较这些组之间的结局。
有系膜细胞增生和无系膜细胞增生的受试者完全缓解率存在显著差异（p<0.05），有玻璃样变性和无玻璃样变性的患者完全缓解率也存在显著差异（p<0.05）。根据ROC曲线分析对定量数据确定的截断点，全球瘢痕超过12%的患者和全球瘢痕低于12%的患者在肾功能不全方面存在显著差异（p<0.05）。此外，多因素logistic回归分析强烈提示系膜细胞增生和全球瘢痕分别与未完全缓解和进展为肾功能不全相关。
在本研究患者中，系膜细胞增生和玻璃样变性的存在被认为是缓解率较低的预后因素。根据多变量分析，仅发现系膜细胞增生和全球瘢痕分别是FSGS患者完全缓解率较低和进展为肾功能不全的独立预后预测因素。
