Focal sclerosing glomerulopathy. Risk factors of progression and optimal mode of treatment

Int Urol Nephrol. 1991;23(6):619-29. doi: 10.1007/BF02549856.

Abstract

Focal sclerosing glomerulopathy and especially focal segmental glomerulosclerosis (FSGS) have been recognized as a distinct clinical entity, however, there still exist controversies in terms of prognostic risk factors of progression and optimal mode of treatment. A total of 32 patients (2 with focal global sclerosis; FGS, the remainder with FSGS) were followed up for a mean period of 82 months (3-240 months). Fourteen presented with nephrotic syndrome and 18 had proteinuria with or without hypertension. Thirteen patients, all of whom except 1 were nephrotic, received steroid treatment with or without other immunosuppressive agents (cyclophosphamide/cyclosporin A/azathioprine). Three of the steroid-treated remained stable in complete remission; 5 nephrotic non-responders had renal death. The mean slope of 1/creatinine versus time for steroid-treated and non-treated groups was -0.23 and -0.043, respectively (p = 0.04), suggesting that nephrotic range proteinuria might be prognostically important. However, for the population of FSGS/FGS as a whole, only the initial serum creatinine predicted renal survival (p = 0.001 by Cox's regression model). Hypertension and hypercholesterolaemia were not important variables by themselves. Nevertheless, we found that the 9 patients treated with antihyperlipidaemics (gemfibrozil/probucol/cholestyramine/maxEPA) fared better, mean slope being -0.023 versus -0.103 for non-treated, though not reaching statistical significance (p = 0.96). Controlled prospective study involving a larger number of patients might be worthwhile.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cyclophosphamide / administration & dosage
  • Cyclosporine / administration & dosage
  • Drug Therapy, Combination
  • Female
  • Glomerulosclerosis, Focal Segmental / complications
  • Glomerulosclerosis, Focal Segmental / diagnosis
  • Glomerulosclerosis, Focal Segmental / therapy*
  • Humans
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Nephrotic Syndrome / etiology
  • Nephrotic Syndrome / therapy
  • Prednisone / administration & dosage
  • Prognosis
  • Retrospective Studies

Substances

  • Cyclosporine
  • Cyclophosphamide
  • Prednisone