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Abstract: FR-PO1135

Utility of Columbia Classification in Focal Segmental Glomerulosclerosis: Renal Prognosis and Treatment-Response Among the Pathological Variants

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tsuchimoto, Akihiro, Kyushu University, Fukuoka, Japan
  • Matsukuma, Yuta, Kyushu University, Fukuoka, Japan
  • Ueki, Kenji, Kyushu University, Fukuoka, Japan
  • Nakagawa, Kaneyasu, Kyushu University, Fukuoka, Japan
  • Tanaka, Shigeru, Fukuoka Dental College, Fukuoka, Japan
  • Masutani, Kosuke, Fukuoka University, Fukuoka, Japan
  • Mitsuiki, Koji, Fukuoka Red Cross Hospital, Fukuoka, Japan
  • Katafuchi, Ritsuko, National Fukuoka-Higashi Medical Center, Koga, Fukuoka, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
  • Kitazono, Takanari, Kyushu University, Fukuoka, Japan
Background

The utility of the Columbia classification (Col-class) for focal segmental glomerulosclerosis (FSGS) has not yet been fully proven.

Methods

We extracted 201 FSGS patients from 10 nephrology centers in Japan and
investigated the differences of a composite renal endpoint, defined as doubling of serum creatinine and/or development of end-stage renal disease, in pathological variants. Sensitivity analysis was used to prove the utility of the Col-class to predict renal outcomes. Additionally, the renal protective effects of steroids and/or immunosuppression (steroid/IS) were investigated in patients stratified according to Col-class.

Results

The patients were classified into the variants as follows: not otherwise specified (NOS) (n=120, 60%), perihilar (n=31, 15%), cellular (n=24, 12%), tip (n=15, 7%), and collapsing variant (n=11, 5%). No tip variant patients reached the renal endpoint. The renal outcome in the collapsing variant was significantly poorer than those in the NOS (hazard ratio [HR] 3.65, P=0.010), while the outcome in perihilar and cellular variant were similar to those in NOS. In the sensitivity analysis, the area under the receiver operating characteristics curve for the renal endpoint was increased by adding Col-class to a model including common risk factors (P=0.041). Steroid/IS use was associated with good renal outcome in the cellular variant (HR 0.03, P=0.017).

Conclusion

The Col-class is useful to predict renal prognosis in Japanese patients with FSGS. In addition to good prognosis in the tip and poor in the collapsing variant, renal protective effect of steroid/IS in the cellular variant was newly revealed.

Effect of steroid/immunosuppressant use on composite renal survival in each pathological variant of focal segmental glomerulosclerosis.