Can prolonged treatment improve the prognosis in adults with focal segmental glomerulosclerosis?

C. Ponticelli, M. Villa, G. Banfi, B. Cesana, C. Pozzi, A. Pani, P. Passerini, M. Farina, C. Grassi, A. Baroli

Research output: Contribution to journalArticle

Abstract

Eighty nephrotic adults with focal segmental glomerulosclerosis (FSGS) and plasma creatinine lower than 3 mg/dL were given corticosteroids (53 patients) or immunosuppressive agents (27 patients) for a median of 16 and 75 weeks, respectively. Forty-two patients responded with complete remission (29 patients, 36%) or partial remission (13 patients, 16%). Twenty-six patients who did not respond were treated again. Two patients obtained complete remission and 13 partial remission. The probability of remission was associated with treatment with corticosteroids (P = 0.0001; RR, 3.93; 95% CI, 2.00 to 7.72), absence of arterial hypertension (P = 0.0023; RR, 2.59; 95% CI, 1.41 to 4.79), and a percentage of hyaline glomeruli lower than 5% (P = 0.0152; RR, 2.04; 95% CI, 1.15 to 3.64). The probability of being alive at 110 months without doubling of plasma creatinine was 69%. The risk of renal insufficiency was correlated with mesangial proliferation (P = 0.0025; RR, 5.50; 95% CI, 1.82 to 16.60) and with interstitial fibrosis (P = 0.0231; RR, 4.44; 95% CI, 1.23 to 16.08) at initial biopsy. Considering partial or complete remission as a time-dependent variable, only the lack of remission (P = 0.0027; RR, 7.23; 95% CI, 1.98 to 26.33) and mesangial proliferation (P = 0.0069; RR, 4.59; 95% CI, 1.52 to 13.88) were correlated with renal failure. Major side effects were observed in 11 patients (5 infections, 1 peptic ulcer, 2 diabetes, 3 neoplasias). This study shows that 70% of nephrotic adults with FSGS may obtain complete or partial remission and maintain stable renal function for about 10 years when given a prolonged therapy with corticosteroids or immunosuppressive drugs.

Original languageEnglish
Pages (from-to)618-625
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume34
Issue number4
Publication statusPublished - 1999

Keywords

  • Corticosteroids
  • Focal segmental glomerular glomerulosclerosis
  • Glomerulonephritis
  • Immunosuppression
  • Nephrotic syndrome

ASJC Scopus subject areas

  • Nephrology

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  • Cite this

    Ponticelli, C., Villa, M., Banfi, G., Cesana, B., Pozzi, C., Pani, A., Passerini, P., Farina, M., Grassi, C., & Baroli, A. (1999). Can prolonged treatment improve the prognosis in adults with focal segmental glomerulosclerosis? American Journal of Kidney Diseases, 34(4), 618-625.