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[Factors predicting for renal survival in primary focal segmental glomerulosclerosis].

AbstractBACKGROUND:
In Peru, the incidence of primary focal segmental glomerulosclerosis (PFSGS) has considerably increased in the last decade and at the present; it is the first cause of primary glomerulonephritis in adults. Because of its prevalence and high probability to progress to end-stage renal disease (ESRD), we searched for factors with prognostic value for renal survival and proteinuria remission.
SUBJECTS AND METHODS:
Historical cohort of 44 patients. We studied clinical and histological characteristics at the time of renal biopsy and clinical condition and renal function at the end of follow-up. PRINCIPAL OUTCOMES: renal impairment (increase >or=50% of basal creatinine levels and/or ESRD), proteinuria remission (partial 0.3-3.49 g/day and complete < 0.3g/day). Kaplan-Meier's curves and Cox's Multivariate Regression were used.
RESULTS:
The 59% of patients were men. The 54.5% had renal failure, 53.5% nephrotic syndrome and 43.2% hypertension or high blood pressure (HBP) at renal biopsy. The frequency of histological variants was: not otherwise specified (NOS) 75%, cellular 13.6%, tip 6.8% and perihilar 4.5%. The 56.8% received steroids for 4.3 +/- 4.5 months and 32% of these patients were corticodependent. After a mean follow-up of 21.6 +/- 27.8 months, the renal function decreased in 18.2% of patients. The 37.8% and 32.4% of patients reached partial and complete proteinuria remission respectively. Treatment with steroids, antihypertensive therapy and IgM and C3 glomerular deposits were associated with a high renal survival. The treatment with steroids was the only factor that forecasted a high renal survival (hazard ratio or HR: 0.07, 0.01-0.9) and proteinuria remission (HR: 0.2, 0.04-0.9). In general, high blood pressure (HR: 6.2, 1.1-35.2), renal failure (HR: 2.9, 1.1-7.6), cellular variant and interstitial fibrosis (HR: 5.2, 1.02-26.7) were prognostic factors for not achieving proteinuria remission.
CONCLUSIONS:
In primary focal segmental glomerulosclerosis, treatment with steroids forecasted a high renal survival and proteinuria remission. Renal failure and interstitial fibrosis were prognostic factors for not achieving proteinuria remission.
AuthorsJ Rivera Roja, M Pérez, A Hurtado, C Asato
JournalNefrología : publicación oficial de la Sociedad Española Nefrologia (Nefrologia) Vol. 28 Issue 4 Pg. 439-46 ( 2008) ISSN: 0211-6995 [Print] Spain
Vernacular TitleFactores pronósticos de supervivencia renal en glomeruloesclerosis focal y segmentaria primaria.
PMID18662153 (Publication Type: English Abstract, Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Female
  • Glomerulosclerosis, Focal Segmental (complications)
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Renal Insufficiency (etiology)
  • Young Adult

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