Adult FSGS in India: Clinical Outcomes at One Year – I-TANGIBLE Registry Data

 

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Adult FSGS in India: Clinical Outcomes at One Year – I-TANGIBLE Registry Data

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Kavita
Yadav
Kavita Yadav KYadav@georgeinstitute.org.in George Institute for Global Health Renal and Metabolic New Delhi India *
I-TANGIBLE GROUP itangiblegroup@gmail.com George Institute for Global Health Renal and Metabolic New Delhi India -
Vivekanand Jha vjha@georgeinstitute.orgin George Institute for Global Health Renal and Metabolic New Delhi India -
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Focal Segmental Glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in adults, with steroid responsiveness being the most dependable predictor of long-term outcomes. Data on the natural history of adult FSGS in India are limited. We report 1-year outcomes of adults with primary FSGS treated with oral prednisolone and enrolled in the pan-India I-TANGIBLE Registry.

I-TANGIBLE is an ICMR-funded collaborative registry across 13 centres in India, enrolling adult patients with biopsy-proven GN. A total of 621 FSGS patients were recruited between June 2022 and June 2025. One-year follow-up data were available for 184 patients; all the patients treated with prednisolone had nephrotic syndrome. Adjunctive therapy included ACE inhibitors/ARBs and other immunosuppressive agents as clinically indicated. Follow-up assessments at 3, 6, and 12 months included proteinuria, serum albumin, serum creatinine, steroid response, relapse, and complications. Remission was defined per KDIGO guidelines.

A total of 184 patients (100 males, 84 females) with a mean age of 33.38 ±15.2 years were analysed. At baseline, median proteinuria was 4.73 (3.2,6.75) g/day, mean serum albumin 2.49 ±1.7 [median :2.2, (1.7,3) g/dL], and median serum creatinine 0.98 (0.7,1.67) mg/dL. At 12 months, median proteinuria decreased to 0.8 (0.26,1.56) g/day, serum albumin increased to 3.67 ± 0.88 g/dL, and serum creatinine remained stable at 0.89 (0.7,1.165) mg/dL. Overall, 155 (84.2%) patients achieved while 29 (15.8%) were steroid resistant. Relapse occurred in 38 (20.6%) patients, with a median time to relapse of 6 months. 56 (30.43%) patients required second line therapy (30 CNI, 21 RTX,5 MMF, CYC etc.) Treatment-related complications were noted in 30 (16.3%) patients.

Among Indian adults with FSGS and nephrotic syndrome treated with prednisolone, most achieved clinical remission within one year. These findings provide important insights into the short-term outcomes of FSGS in India. Nearly one-third required additional immunosuppressive therapy to maintain remission.

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