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Abstract: FR-PO1131

Clinical and Histological Risk Factors Predicting Progression to ESRD in Patients with Secondary FSGS

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Pawar, Aditya S., Mayo Clinic , Rochester, Minnesota, United States
  • Rule, Andrew D., Mayo Clinic , Rochester, Minnesota, United States
  • Lao, Kriselle maris, Mayo Clinic , Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic , Rochester, Minnesota, United States
  • Vaughan, Lisa E., Mayo Clinic , Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic , Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic , Rochester, Minnesota, United States
Background

Secondary FSGS is a proteinuric renal disease that develops as a result of increased hemodynamic stress on the glomeruli. The aim of study was to identify clinical characteristics and histological factors in patients with secondary FSGS that predicted progression to ESRD.

Methods

Adult patients (>18 y) with a native kidney biopsy and diagnosis of FSGS between 1993-2015 were identified. Those with additional glomerular lesions (e.g. diabetes or vasculitis) or missing clinical or biopsy data were excluded. Comprehensive chart review was performed on the remaining FSGS patients to identify candidate clinical and histological predictors (n=149). Cox proportional hazards regression models were used to identify predictors for incident ESRD (eGFR <15 or need for transplantation or dialysis).

Results

Out of 149 patients, 60 had primary FSGS (S. albumin <3.5 g/dL & urinary protein (UP) ≥ 3.5g/24h), 89 had secondary FSGS (S. albumin ≥3.5 g/dL & any degree of proteinuria).In patients with secondary FSGS mean (SD) age was 52 (17) years, 41% female, & 73% white. Median [IQR] BMI was 30 [26-34] kg/m2, S. creatinine was 1.7 [1.3-2.4] mg/dL, eGFRcreatinine was 40 [28-57] ml/min, 24h UP was 2.6[1.3-4.4] g, and median follow-up was 34 [12-60] months. ESRD occurred in 33% of these patients. Clinical predictors of ESRD were older age, lower eGFR, use of immunosuppression, and absence of renin-angiotensin blockade (Table 1). The only renal biopsy histological predictor of ESRD was severe arteriosclerosis, though IFTA was borderline significant. The degree of global sclerosis, foot process effacement and glomerulomegaly was not predictive. Severe arteriosclerosis was predictive after adjusting for age (p=0.04).

Conclusion

Arteriosclerosis appears to be an important and under-recognized predictor of progression to ESRD in patients with secondary FSGS independent of age.

Univariate analysis
VariableHazard Ratio(CI) (P value)
Female
Age @ Biopsy / 10 years
0.5 (0.08-1.77) (0.36)
1.66 (1.22-2.37) (0.002)
eGFR per 10 ml/min0.96 (0.53-0.94) (0.03)
Urine Protein per g/day1.08(0.93-1.23) (0.21)
Global glomerulosclerosis per %1.00(0.98-1.02) (0.38)
IFTA >50%2.4 (0.97 – 6.8) (0.07)
Arteriosclerosis > 50%7.26 (1.87-24.43) (0.001)
Use of immunosuppression
Use of ACE-I/ARB
1.38(0.39-3.88) (0.04)
0.3 (0.12-0.72) (0.008)