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Focal segmental glomerulosclerosis (FSGS) is the most frequent primary glomerulopathy in México and the one that most frequently progresses to chronic kidney disease, with a 10-year global renal survival of 50%. Therefore, it is important to identify the factors that predict the progression of renal disease. The first line of treatment recommended in the KDIGO guidelines is prednisone with which partial remission + complete remission of proteinuria is achieved in 50-64% of patients. However, little is known about the significance of the initial response to prednisone in the progression of renal disease.
It was a retrospective study in adults with biopsy-proven primary focal segmental glomerulosclerosis and nephrotic syndrome attended at National Medical Center “La Raza” in Mexico City. All patients received first-line prednisone 50 mg every 24 hours, tapered over at least 16 weeks. Patients were divided into two groups according to response to treatment: 1) patients with partial or complete remission using KDIGO definitions and 2) patients without remission. Survival analysis was performed using the Kaplan-Meier method and differences between groups were determined using log rank test. A value of p<0.05 was considered significant.
A review of clinical records, between January 2010 and December 2022 identified 238 patients with biopsy-proven focal segmental glomerulosclerosis and nephrotic syndrome, 62 cases considered as secondary were excluded from the analysis and 176 patients were included to the analysis, aged de 36.76 + 13.67 years, with a predominance of the male gender (90 cases, 51.1%). The clinical presentation at the time of the biopsy was with proteinuria of 8.61 + 5.45 g/24 hours, creatinine of 1.30 ± 0.87 mg/dL, serum albumin of 2.34 + 0.94 g/dL and glomerular filtration rate estimated by CKD-EPI of 79.59 ± 36.69 ml/min. Renal survival at 60 months was 96% and doubling of creatinine free survival was 93.8%. Renal survival at 60 months was similar between the remission and non-remission groups treated with prednisone (97.6% and 92.0% respectively, p=0.78). However, the group that achieved partial or complete remission of proteinuria with prednisone had a significantly higher doubling of creatinine free survival (98.4%) in contrast to the non-remitting group with prednisone (82.0%), p<0.001.
The response to treatment with prednisone (partial or complete remission of proteinuria) is related to better doubling of creatinine free survival at 60 months.