Long-term Prognostic Factors in Pediatric Focal Segmental Glomerulosclerosis

ABSTRACT

PURPOSE: Efforts to predict long-term outcome of focal segmental glomerulosclerosis(FSGS) have been made but have yielded conflicting results. Reports are rare especially in pediatric patients. In this study, we reviewed the predictable prognostic factors in patients of FSGS. METHOD: Fifty children who diagnosed as biopsy-proven FSGS at depart- ment of pediatrics at Yonsei university were studied retrospectively. Based on medical records, response to treatment and pathologic slides, we compared normal renal function group and decreased renal function group, assessed the factors affecting renal survival and progression to renal failure. RESULTS: The mean age at onset was 8 1/12 years, sex ratio was 2.3 1, and the mean duration of follow-up was 7 1/12 years. The overall renal survival rate was 34% at 5 years, 8% at 10 years. Five-year survival rate was 74% in normal renal function group and 27% in decreased renal function group. Between the two groups, there were no significant differences in age at onset, sex ratio, amount of proteinuria, incidence of hematuria and hypertension, mesangial hypercellularity. Decreased renal function group showed higher serum creatinine level, poor response to treatment, higher percent of glomeruli with sclerosis, moderate to severe tubulointerstitial change and vascular change(p<0.05). The prognostic factors of renal survival rate were same as above and incidence of hypertension also affected renal survival(p<0.05). The progression rate to renal failure did not show statistically significant factor. CONCLUSION: We reviewed the factors affecting long-term outcome of FSGS. Serum creatinine level, steroid responsiveness, and the degree of glomerulosclerosis were significant prognostic factors.