ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: TH-PO610

Clinicopathologic Prognostic Factors to Estimate ESKD in Patients with FSGS

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • You, Eun Mi, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)
Background

FSGS can be caused by heterogenous aetiologies with subdivided by primary, secondary, and genetical forms. However, the classification may not provide future outcomes of FSGS. We searched for prognostic markers of any form of FSGS.

Methods

We enrolled a total of 20,404 adult patients who underwent native renal biopsy from 1979 to 2018 in 18
hospitals in Korea. We selected patients with definite segmental sclerosis by light microscopic examination including ≥10 glomeruli and without electron dense deposits by electron microscopic examination. We excluded patients with other forms of pathologic diagnosis
except FSGS, with diabetes mellitus, or with follow-up period < 6 months after renal biopsy. We evaluated prognostic factors to estimate the risk of ESRD.

Results

Among 511 patients, GFR <60 ml/min/1.73 m2 was found in 41.5 % of patients and UPCR ≥ 3.0 g/g creatinine in 41.1% of patients. During 117.5 ± 100.1 months of follow-up period, there were 97 (19.0%) patients with incident ESRD. The prognostic factors to incident ESRD were estimated GFR, diastolic blood pressure, year of renal biopsy, glomerular size, amount of global sclerosis (GS) and segmental sclerosis (SS), severity of increase in glomerular matrix, interstitial fibrosis, interstitial inflammation, and tubular atrophy (TA), and presence of artherosclerosis of intrarenal vessels. Adjusted with clinicopathologic factors related to incident ESRD, only pathologic findings of GS, SS, and TA were the independent prognostic factors. AUC by ROC to estimate the event of ESRD by percentage of GS was 0.601 (range; 0.538-0.663, p=0.002) and, by percentage of SS, 0.679 (range; 0.616-0.743, p<0.001). We grouped patients with three pathology categorical variables of a criterion of GS 30.9 %, SS 10.5 %, and moderate degree in severity of TA into 4 groups according to the relative risk to develop ESRD. UPCR was a significant risk factor to estimate ESRD only in a Group 4 with the criterion of 2 g/g creatinine by the Kaplan-Meier test (p=0.034). GFR was not a prognostic factor in any pathology subgroup.

Conclusion

Important prognostic factors to estimate incident ESRD were pathologic findings of GS, SS and TA. Significance of UPCR and GFR as prognostic factors was varied according to pathologic findings. We need to reconsider the criterion of UPCR to initiate immunosuppressive
treatment according to pathologic findings at renal biopsy.