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Abstract: TH-PO478

Evaluating the Predictors of Structural Features in Kidney Biopsies From Adults With Focal Segmental Glomerulosclerosis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Tuttle, Katherine R., Providence Health, Spokane, Washington, United States
  • Abner, Clint, Arkana Laboratories, Little Rock, Arkansas, United States
  • Walker, Patrick D., Arkana Laboratories, Little Rock, Arkansas, United States
  • Wang, Kaijun, Travere Therapeutics Inc, San Diego, California, United States
  • Bunke, Martin C., Travere Therapeutics Inc, San Diego, California, United States
  • Heo, Ji Haeng, Genesis Research LLC, Hoboken, New Jersey, United States
  • Rava, Andrew, Genesis Research LLC, Hoboken, New Jersey, United States
Background

Focal segmental glomerulosclerosis [FSGS] is a lesion of glomerular injury in patients with nephrotic syndrome. The aim of this study was to assess clinical predictors of FSGS histological severity among adults undergoing kidney biopsy.

Methods

A real-world data study was performed using the Arkana Biopsy database (1Jan2016–31May2020). Inclusion criteria: ≥18 years, ≥1 FSGS positive biopsy, no prior kidney transplant. Associations between chronic kidney disease [CKD] stage (eGFR by 2021 CKD-EPI-creatinine equation) and nephrotic range proteinuria (<3.0 g/g or <3.5 g/day vs. ≥3.0 g/g or ≥3.5 g/day) at the time of biopsy and FSGS structural features (severe: interstitial fibrosis and tubular atrophy [IFTA] >25% and global glomerulosclerosis [GS] >50% vs. non-severe) were analyzed using multivariate logistic regression. Models were adjusted for age, sex, race, and hypertension status.

Results

In 2,011 patients with biopsy proven FSGS, CKD stage 3A (OR 4.5, p=0.002) and CKD stages 3B–5 (OR 12.2–22.1, p<0.001) predicted severe histological features, whereas nephrotic range proteinuria did not (Table 1). Younger age at biopsy, non-White racial identity, and hypertension also predicted severe histologic features (p<0.05).

Conclusion

Severe histologic features of FSGS are predicted by later CKD stage, but not nephrotic range proteinuria, at the time of kidney biopsy. Strategies for earlier diagnosis before onset of eGFR decline and severe structural injury, particularly in younger, non-White, and hypertensive patients, are needed to improve kidney disease outcomes in patients with FSGS.

Funding

  • Commercial Support