Prognostic value of clinical, laboratory, and morphological factors in patients with primary focal segmental glomerulosclerosis - distribution of pathological variants in the Croatian population
Jadranka Vlasić-Matas, Merica Glavina Durdov, Vesna Capkun, Kresimir Galesić
Med Sci Monit 2009; 15(10): PH121-128
Scant data are available on the prognosis and distribution of subtypes of focal segmental glomerulosclerosis (FSGS) using the new Columbia classification in European populations. We assessed the predictive value of the clinical, laboratory, and morphological data obtained at the time of diagnosis, established on the basis of kidney biopsy, for the prognosis of primary FSGS.
Material and Method: Sixty adults with FSGS were included in the study. Patients' clinical status, routine laboratory data, and histopathological findings were correlated with patients' remission status after a 5-year follow-up and patients' injury score (IS).
Results: Thirty-eight patients had remission of the disease and 22 patients did not. A value of IS>0.84 was more often found in patients who did not reach remission, whereas IS <0.34 was more frequent in patients who did reach remission (P=0.002). Serum creatinine and creatinine clearance correlated with IS (P<0.001), but proteinuria showed no correlation. FSGS subtypes were distributed as follows: tip variant in 3 (5%) patients, cellular variant in 4 (7%), not otherwise specified variant in 15 (25%), and perihilar variant in 38 (63%) patients. Collapsing variant of FSGS was not found in any of the patients included in the study.
Conclusions: Injury score is the most reliable prognostic predictor in patients with primary FSGS. Patients with perihilar variant were most frequent, whereas collapsing variant was not found at all in the Croatian population.
Keywords: Middle Aged, Prognosis, Male, Inflammation - complications, Immunosuppression, Immunosuppressive Agents - therapeutic use, Hypertension - complications, Humans, Glomerulosclerosis, Focal Segmental - pathology, Female, European Continental Ancestry Group, Croatia, Clinical Laboratory Techniques, Aged, Adult, Adolescent, Remission Induction, young adult