Focal segmental glomerulosclerosis natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
The most important poor prognostic factors in focal segmental glomerulosclerosis (FSGS) are | The most important poor prognostic factors in focal segmental glomerulosclerosis (FSGS) are<ref name="FSGS">{{cite web |url=http://cdn.intechopen.com/pdfs/22820/InTech-Focal_segmental_glomerulosclerosis.pdf|title= Focal segmental glomerulosclerosis.|last1= Sohal |first1= DS |last2= Prabhakar |first2= SS|date=November 02, 2011|website= Interchopen |publisher= InTech |accessdate=3 December 2013}}</ref>: | ||
*Massive or nephrotic-range proteinuria | *Massive or nephrotic-range proteinuria | ||
*Level of serum creatinine > 1.3 mg/dL | *Level of serum creatinine > 1.3 mg/dL | ||
Line 25: | Line 25: | ||
*Black race | *Black race | ||
According to a 10-year study in 1999, Approximately 50% of patients with heavy proteinuria in the nephrotic-range progress to end-stage renal disease (ESRD) within 3-8 years. | According to a 10-year study in 1999, Approximately 50% of patients with heavy proteinuria in the nephrotic-range progress to end-stage renal disease (ESRD) within 3-8 years.<ref name="pmid10382985">{{cite journal| author=Korbet SM|title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. |journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 |pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> In converse, patients with non-nephrotic range proteinuria often have a better prognosis, with a 10-year survival reaching > 80%.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> While spontaneous remission is highly uncommon in FSGS, occurring in less than 6% of patients, the degree of proteinuria may predict the probability of spontaneous remission.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> | ||
Serum creatinine > 1.3 mg/dL and interstitial fibrosis > 20% on pathological analysis have been associated with worse renal outcomes.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> The extent of proteinuria, serum creatinine, and extent of fibrosis on pathological observation have been positively correlated.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> | Serum creatinine > 1.3 mg/dL and interstitial fibrosis > 20% on pathological analysis have been associated with worse renal outcomes.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> The extent of proteinuria, serum creatinine, and extent of fibrosis on pathological observation have been positively correlated.<ref name="pmid10382985">{{cite journal| author=Korbet SM| title=Clinical picture and outcome of primary focal segmental glomerulosclerosis. | journal=Nephrol Dial Transplant | year= 1999 | volume= 14 Suppl 3 | issue= | pages= 68-73 | pmid=10382985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10382985 }} </ref> |
Revision as of 22:42, 3 December 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:’’’ Cafer Zorkun, M.D., Ph.D. [2]
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Overview
Natural History
Complications
Prognosis
The most important poor prognostic factors in focal segmental glomerulosclerosis (FSGS) are[1]:
- Massive or nephrotic-range proteinuria
- Level of serum creatinine > 1.3 mg/dL
- Collapsing variant on morphological appearance
- Presence of tubulointerstitial fibrosis
- Absence of remission or partial remission
- Black race
According to a 10-year study in 1999, Approximately 50% of patients with heavy proteinuria in the nephrotic-range progress to end-stage renal disease (ESRD) within 3-8 years.[2] In converse, patients with non-nephrotic range proteinuria often have a better prognosis, with a 10-year survival reaching > 80%.[2] While spontaneous remission is highly uncommon in FSGS, occurring in less than 6% of patients, the degree of proteinuria may predict the probability of spontaneous remission.[2]
Serum creatinine > 1.3 mg/dL and interstitial fibrosis > 20% on pathological analysis have been associated with worse renal outcomes.[2] The extent of proteinuria, serum creatinine, and extent of fibrosis on pathological observation have been positively correlated.[2]
While collapsing variant, commonly seen in HIV-induced FSGS, is associated with poorer outcomes, tip variant correlates with better outcomes.[3] According to Korbet and colleagues, the remission of proteinuria is negatively associated with progression to ESRD in FSGS.[2]
References
- ↑ Sohal, DS; Prabhakar, SS (November 02, 2011). "Focal segmental glomerulosclerosis" (PDF). Interchopen. InTech. Retrieved 3 December 2013. Check date values in:
|date=
(help) - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Korbet SM (1999). "Clinical picture and outcome of primary focal segmental glomerulosclerosis". Nephrol Dial Transplant. 14 Suppl 3: 68–73. PMID 10382985.
- ↑ Thomas DB, Franceschini N, Hogan SL, Ten Holder S, Jennette CE, Falk RJ; et al. (2006). "Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants". Kidney Int. 69 (5): 920–6. doi:10.1038/sj.ki.5000160. PMID 16518352.