Greenwood, A.M., Gunnarsson, R., and Baer, R. (2014) Primary focal segmental glomerulosclerosis: a systematic review of clinical presentation, treatment and outcomes in adults. In: Nephrology (19) 61. p. 33. From: 50th Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology, 24-27 August 2014, Melbourne, VIC, Australia.

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Abstract

Aim: To systematically review evidence which describes clinical features, treatment and outcomes in adult patients with primary Focal Segmental Glomerulosclerosis (FSGS).

Background: Primary FSGS is one of the most common glomerular diseases to progress to end stage kidney disease (ESKD) unless remission is achieved with immunosuppression. Renewed interest is due to increasing incidence of ESKD attributed to FSGS in conjunction with the increasing burden of ESKD on the patient, family and society at large.

Methods: We searched databases to identify studies which assessed clinical presentation, treatment and outcomes in adult patients with primary FSGS. Quality of studies was assessed using a modified validated checklist. Outcomes assessed included treatment response and renal dysfunction. Findings were summarized descriptively.

Results: We included 11 retrospective studies of 1,091 patients. Six were single-centre and 5 were multi-centre. Follow-up ranged from 36 months to 10 years. Seven of 8 studies showed a male predominance with ethnicity (white/black) equally distributed between 4 studies with comparisons. The majority of patients in all studies presented with nephrotic range proteinuria and haematuria. Immunosuppressive therapy was the mainstay of treatment in 7 of 10 studies with 7 of these studies experiencing remission rates ≥50%. Five studies found response to treatment improved renal survival (p = <0.05) with 3 defining this treatment to be corticosteroids.

Conclusions: Current evidence suggests that the best clinical indicator of long term prognosis is induction of remission by corticosteroid therapy. The role of histological subtypes and clinical variables at presentation requires further investigation. These findings are based on small observational studies of suboptimal quality. More large, well-designed and reported studies are needed to influence clinical practice and promote informed individualized patient management.

Item ID:	37963
Item Type:	Conference Item (Abstract / Summary)
ISSN:	1440-1797
Additional Information:	Special Issue of Nephrology: 50th Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology, 25–27 August 2014, Melbourne Convention and Exhibition Centre Melbourne, Australia Nephrology, Volume 19, Issue Supplement S4, pages 17–57, August 2014.
Date Deposited:	24 Mar 2015 22:55
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110312 Nephrology and Urology @ 100%
SEO Codes:	92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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