Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis.
Renal histological features of focal segmental glomerulosclerosis (FSGS) are found in 75% of pediatric patients with steroid-resistant nephrotic syndrome. In order to evaluate the predictive factors of chronic kidney disease (CKD), we retrospectively reviewed the records of 110 children with biopsy-proven FSGS admitted between 1972 and 2004. Renal survival was analyzed by the Kaplan-Meier method and Cox's regression model. Two multivariate models were developed: (1) from the onset of symptoms to the occurrence of CKD and (2) from the time of renal biopsy to CKD. Mean follow-up time was 10 years [standard deviation ((SD) 5.5], and 24 patients (21.8%) progressed to CKD. At baseline, after adjustment three variables remained as independent predictors of CKD: age >6.5 years (RR=3.3, 95% CI=1.3-7.8), creatinine >1 mg/dl (RR=2.5, 95% CI=0.97-6.5), and non-response to steroids (RR=7.3, 95% CI=2.7-19.7). In a model with continuous variables only age and non-response to steroids were associated with CKD. At the time of renal biopsy, after adjustment two variables remained as independent predictors of CKD: hematuria (RR=3.0, 95% CI=1.2-7.3) and creatinine >0.8 mg/dl (RR=4.3, 95% CI=1.7-10.6). In a model with continuous variables four factors predicted CKD: age, creatinine, hematuria, and percentage of global sclerosis.
Abrantes
Marcelo M
MM
Pediatric Nephrourology Unit, Hospital das Clínicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Cardoso
Luis Sergio B
LS
Lima
Eleonora M
EM
Penido Silva
José M
JM
Diniz
José S
JS
Bambirra
Eduardo A
EA
Oliveira
Eduardo A
EA
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D003404:Creatinine