The Clinical Manifestation and Outcome of Adult Patients with FSGS in Korea / 대한신장학회잡지

ABSTRACT

BACKGROUND: Recently, it was reported that the incidence of FSGS has increased and that the corticosteroid treatment could improve its prognosis in the case of the adult patients. However, little is known about the clinical outcome and prognosis of patients with FSGS especially in Korean Adults. We performed a retrospective clinical study in 92 Korean adults with primary FSGS to determine clinical factors that have influence on the prognosis. METHODS: The subjects of this study were all adult patients(age >or=16 years) who had been diagnosed as primary FSGS through a renal biopsy between 1985 and 1999, and the patients affected by the secondary cause were excluded. We analyzed the clinical manifestation of all patients at that time of renal biopsy. In addition, in the case of patients who were followed more than 10 weeks, the rate of deterioration of renal function was analyzed retrospectively. RESULTS: Of the 92 patients, 47(51%) patients were nephrotic and 45(49%) were non-nephrotic. In terms of gender, 58(63%) of the patients were male, and 34(37%) were female. At that time of renal biopsy, 51% were in the state of renal insufficiency, and 45% were hypertensive. There was no significant difference in clinical findings of nephrotic and non-nephrotic patients at biopsy except the amount of proteinuria. Among them, 88 patients were followed up at least 10 weeks. The median of the follow-up was 37 months(from 2.5 to 185). Of the 88 patients, the renal function of 14 patients deteriorated during the follow-up; at least 50% increment of plasma creatinine over the baseline values. There was no significant difference in clinical characteristics between 14 patients and the others. The result of a multivariate analysis on clinical factors(age, hypertension, the degree of proteinuria, advanced renal insuffiency, steroid therapy) showed that nephrotic range of proteinuria, advanced renal insufficiency, and no steroid treatment were independent predictors for poor renal outcome. Overall, 80% of the 88 patients maintained stable state of a renal function for five years irrespective of steroid treatment. In the case of nephrotics, 34 patients(77%) were treated with corticosteroid. Only one out of 34 patients experienced the deterioration of renal function. On the other hand, 6 out of 10 nephrotic patients who did not launch steroid treatment, revealed worsening of renal function. CONCLUSION: The above findings suggest that corticosteroid treatment would be helpful for nephrotic adults with FSGS. Furthermore, these findings underscore the need for a controlled trial in patients with FSGS to confirm the responsiveness of corticosteroid treatment and to establish guidelines of therapy.