Clinical presentation, treatment and outcome of focal segmental glomerulosclerosis in Far North Queensland Australian adults

Greenwood, Alice M., Gunnarsson, Ronny, Neuen, Brendon L., Oliver, Kimberley, Green, Stella J., and Baer, Richard A. (2017) Clinical presentation, treatment and outcome of focal segmental glomerulosclerosis in Far North Queensland Australian adults. Nephrology, 22 (7). pp. 520-530.

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Abstract

Aim: To describe the clinical features, treatment and outcomes in Australian adults with focal segmental glomerulosclerosis and identify predictors of disease progression and all-cause mortality.

Methods: The study included all patients with biopsy confirmed focal segmental glomerulosclerosis between January 1997 and June 2014 at participating hospitals. Clinical factors, histopathological findings, biochemical markers and treatments were analysed and potential predictors of doubling serum creatinine, end stage kidney disease or death identified.

Results: 98 patients were included with a median follow-up of 4.3 years. 34 (35%) patients were Aboriginal or Torres Strait Islander. Focal segmental glomerulosclerosis not otherwise specified was the most common variant. 17 (59%) patients initially treated with immunosuppression experienced an improvement in renal function. At the end of follow-up 43 (44%) patients had progressed to the composite outcome. Baseline tubulointerstitial scarring and lower haemoglobin predicted shorter time to doubling serum creatinine. Dual diagnosis, higher serum creatinine, lower estimated glomerular filtration rate and doubling creatinine were associated with shorter time to end stage kidney disease with remission the only protective factor. Age was the only variable associated with all-cause mortality.

Conclusion: Focal segmental glomerulosclerosis holds serious implications for patients. Concomitant diabetic nephropathy, higher serum creatinine and lower estimated glomerular filtration rate at renal biopsy were associated with poorer renal prognosis. Indigenous people had a female predominance and are over-represented in relation to their population size, however were not associated with poorer prognosis. Remission was the only modifiable variable and thus should be at the forefront of patient management goals and future studies.

Item ID: 45049
Item Type: Article (Research - C1)
ISSN: 1440-1797
Keywords: focal segmental glomerulosclerosis, nephrotic syndrome, end stage kidney disease, adult, prognosis
Date Deposited: 07 Aug 2016 23:24
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110312 Nephrology and Urology @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 100%
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