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Kidney Week

Abstract: PO1891

Long-Term Renal Outcomes in Focal Segmental Glomerulosclerosis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Forster, Benjamin Michael, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Olson, Stephen W., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background

Focal Segmental Glomerulosclerosis (FSGS) is a glomerular disease defined by pathognomonic histopathology but is caused by multiple mechanisms of disease, not all of which have been fully elucidated. Therefore, the reported renal prognosis, treatment strategies, and treatment response has varied significantly in previous small case series. We sought to analyze long term renal survival and associated risk factors in the largest cohort over the longest period of follow up described to date.

Methods

We performed a retrospective cohort study on all previous and current active duty military with biopsy proven FSGS. Potential cases were identified through query of the military electronic medical record for International Classification of Diseases 9 and 10 codes (581.1, 582.1, and N04) and then confirmed by comprehensive chart review. Extensive data collection was performed and then analyzed using STATA 16.

Results

We identified 348 patients with biopsy proven FSGS with a mean follow up of 9.5 years. The majority were black, male, and under 40 years old. Progression to end stage kidney disease (ESKD) was 14%, 25%, and 35% at 5 years, 10 years, and 15 years after diagnosis, respectively. More patients with nephrotic range proteinuria progressed to ESKD (20%, 31%, and 49% at 5, 10, and 15 year follow up, respectively) than non-nephrotic range proteinuria (13%, 20%, and 31% at 5, 10, and 15 year follow up, respectively), and no significant proteinuria (6%, 14%, and 23% at 5, 10, and 15 year follow up, respectively); p=0.04. Overall progression to stage 3 chronic kidney disease (CKD3) was 32%, 40% and 50% at 5, 10, and 15 years after diagnosis, respectively. Full remission from initial treatment was associated with a substantial reduction in progression to ESKD (2%, 4%, and 7% at 5,10, and 15 years follow up, respectively) compared to partial remission (12%, 21%, and 30%) and no remission (27%, 45%, 63%) , p<0.001.

Conclusion

We present the largest cohort of biopsy proven FSGS cases over the longest follow up period to date. Approximately one third of all FSGS patients develop ESKD and one half developed CKD3 within 15 years. Proteinuria significantly increased the risk of progression to ESKD. Achieving a full or partial remission after initial treatment significantly decreased the risk of progression to ESKD.