title: Renal Survival in Patients with Collapsing Compared with Not Otherwise Specified FSGS.
abstract: Idiopathic collapsing FSGS has historically been associated with poor renal outcomes. Minimal clinical data exist on the efficacy of immunosuppressive therapy. Our study sought to provide a comprehensive description of renal survival in patients with collapsing and not otherwise specified FSGS after controlling for factors affecting renal prognosis.
  
  
  
  We performed a retrospective analysis of an inception cohort study of patients diagnosed between 1989 and 2012. All potential patients with collapsing FSGS fulfilling the inclusion criteria were identified and compared with patients with not otherwise specified FSGS (approximately 1:2 ratio) on the basis of biopsy report and record availability. Time to ESRD was analyzed using Cox proportional hazards models.
  
  
  
  In total, 187 patients were studied (61 collapsing and 126 not otherwise specified), with a mean follow-up of 96 months. At baseline, patients with collapsing FSGS had higher median proteinuria (12.2 [5.6-14.8] versus 4.4 [2.3-8.1] g/d, respectively;P<0.001), lower median albuminemia (2.4 [1.9-3.0] versus 2.9 [1.8-3.7] g/dl, respectively;P=0.12), and lower median eGFR (48 [26-73] versus 60 [42-92] ml/min per 1.73 m2, respectively;P=0.01) than patients with not otherwise specified FSGS. The proportion of patients with remission of proteinuria was similar in patients with collapsing FSGS and patients with not otherwise specified FSGS (65.7% [23 of 35] versus 63.2% [72 of 114], respectively;P=0.84). The overall renal outcome (ESRD defined as eGFR<15 ml/min per 1.73 m2, dialysis, or transplantation) of patients with collapsing FSGS was not poorer than that of patients with not otherwise specified FSGS in multivariate analyses after adjusting for baseline characteristics and immunotherapy (hazard ratio, 1.78; 95% confidence interval, 0.92 to 3.45).
  
  
  
  Compared with not otherwise specified FSGS, idiopathic collapsing FSGS presented with more severe nephrotic syndrome and lower eGFR but had a similar renal survival after controlling for exposure to immunosuppressive treatment. These results highlight the importance of early diagnosis and institution of immunosuppressive therapy in patients with collapsing FSGS.
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.|Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Laurin
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Adil M
authors.initials: AM
authors.lastname: Gasim
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Derebail
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.|Triangle Integrative Medicine Associates, Chapel Hill, North Carolina; and.
authors.forename: JulieAnne G
authors.initials: JG
authors.lastname: McGregor
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.|Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Kidd
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hogan
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Poulton
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Randal K
authors.initials: RK
authors.lastname: Detwiler
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: J Charles
authors.initials: JC
authors.lastname: Jennette
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
authors.affiliation: University of North Carolina Kidney Center, Division of Nephrology and Hypertension and.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Nachman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000652:urine; D012074:Remission Induction; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D012709:Serum Albumin
keywords: Follow-Up Studies; Humans; Kidney Failure, Chronic; Prognosis; Proportional Hazards Models; focal segmental glomerulosclerosis; glomerular filtration rate; glomerulonephritis; immunosuppression; nephrotic syndrome; proteinuria; renal dialysis