Prediction of the progression of renal failure in adult and in pediatric patients with malignant focal glomerulosclerosis.
A retrospective analysis of the progression of renal failure was performed in 6 children and 5 adults with idiopathic nephrotic syndrome unresponsive to steroids and immunosuppressants and with histological findings of focal glomerulosclerosis. We analyzed the linear regression of Ccr and of their logarithmic transformation vs time (months) starting from the time when the first abnormal value was observed (t = 0). The regression analysis was performed at three different times, when Ccr was: 30-20, 20-25 and 10-15 ml/min/1.73 sqm. Extrapolation of each of these lines on the x axis predicted when renal function would be zero. The difference in months, between the predicted and actual time of starting dialysis was prediction error. "r" values were always elevated and statistically significant for both linear and logarithmic regression; there was a large intersubject variability in the rate of loss of renal function but the mean prediction error at various levels of Ccr was within limits clinically acceptable. Moreover its magnitude did not significantly decrease by prolonging the time of observation. This indicates that in this disease the decay of Ccr enters a track which proceeds linearly or logarithmically after the onset of renal failure and no major deviation from the predicted line is to be expected. The good predictability in our study may be attributed to the fact that our patients were homogeneous for a number of factors which may be relevant to progression of the disease. It confirms the view supported by Gretz et al. [1983] that there is a need for stratification of patients in large cohort studies on the predictability of loss of renal function.
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005921:Glomerulonephritis / Q000503:physiopathology*; D005923:Glomerulosclerosis, Focal Segmental / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D009404:Nephrotic Syndrome / Q000503:physiopathology; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors