Department of Medicine, Nephrology Section, Iran University of Medical Sciences (IUMS), Hasheminejad Kidney Center (HKC), Tehran, Iran.
Iran J Kidney Dis. 2021 Dec;15(6):408-418.
Focal segmental glomerulosclerosis (FSGS) is one of the important causes of end stage kidney disease (ESKD). We evaluated the progression risk factors of primary FSGS to chronic kidney disease (CKD) or ESKD with a predictive model including clinical and histological predictors.
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.
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 to 1.70) and 1% increase in glomeruli with segmental glomerulosclerosis (SGS) (HR = 1.03, 95% CI: 1.02 to 1.04) or interstitial fibrosis/tubular atrophy (IF/TA) (HR = 1.03, 95% CI: 1.01 to 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 to 0.90). Median renal survival was 3.1 years (95% CI: 2.2 to 4.1 years) in patients with highest risk score (baseline eGFR < 25 mL/min/1.73m2 + IF/TA/SGS > 50%), and 8.1 years (95% CI: 7.7 to 8.6 years).in those with lowest score (baseline eGFR > 75 mL/ min/1.73m2 + IF/TA/SGS < 5%).
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. DOI: 10.52547/ijkd.6442.
局灶节段性肾小球硬化症（FSGS）是终末期肾病（ESKD）的重要病因之一。我们评估了包括临床和组织学预测因子在内的预测模型中原发性 FSGS 向慢性肾脏病（CKD）或 ESKD 进展的风险因素。
研究了 201 名原发性 FSGS 患者（59%为男性，平均年龄：38±15 岁）。使用时间依赖性 Cox 模型和 C 统计量进行预测模型。估计了独立变量之间的相互作用和相关性。
在 55±27 个月的随访期间，82 名患者（41%）出现 CKD（46 名）或 ESKD（36 名）。在调整后的模型中，基线时血清肌酐（SCr）升高 1 单位（HR=1.39，95%CI：1.15 至 1.70）和肾小球节段性肾小球硬化（SGS）增加 1%（HR=1.03，95%CI：1.02 至 1.04）或间质纤维化/肾小管萎缩（IF/TA）（HR=1.03，95%CI：1.01 至 1.05）都会增加 CKD/ESKD 的风险。在调整后的模型中，较高的基线蛋白尿和塌陷变体与 CKD/ESKD 风险无关。通过将 SGS 和 IF/TA 评分添加到基线 SCr 中，C 统计量的区分度为 0.83（95%CI：0.77 至 0.90）。在风险评分最高的患者（基线 eGFR<25mL/min/1.73m2+IF/TA/SGS>50%）中，中位肾脏生存率为 3.1 年（95%CI：2.2 至 4.1 年），而在风险评分最低的患者（基线 eGFR>75mL/min/1.73m2+IF/TA/SGS<5%）中为 8.1 年（95%CI：7.7 至 8.6 年）。
在原发性 FSGS 中，较高的基线 SCr、增加的 SGS 和 IF/TA，但不是基线蛋白尿和塌陷病理学，是 CKD/ESKD 的预测因子。这些发现表明及时发现和转介对原发性 FSGS 预后的重要性。DOI：10.52547/ijkd.6442.
