Age and ethnicity affect the risk and outcome of focal segmental glomerulosclerosis

In patients with proteinuria, African-American (AA) ethnicity is reported t o be a risk factor for focal segmental glomerulosclereosis (FSGS) and its p rogression to end-stage renal disease (ESRD). We reviewed our single-center experience to determine the probability of FSGS and its progression to ESR D based on ethnicity and age at presentation in children with proteinuria w ith or without nephrotic syndrome. Proteinuria without systemic disease or acute glomerulonephritis was the presenting feature in 17% (236/1,403) of c hildren in the renal patient database of Texas Children's Hospital, Baylor College of Medicine. Histopathological diagnoses were established in 107 of 236 patients (45%). FSGS was identified in 65 patients, accounting for 28% of all patients with proteinuria and 61% of patients who underwent renal b iopsy. FSGS was more prevalent in AA (45%) than in non-AA patients (22%) (P =0.001), and AA patients with FSGS were older at presentation (12.7+/-4.4 y ears) than non-AA patients (5.6+/-4.6 years) (P<0.001). Among patients who underwent renal biopsy, increasing age at presentation increased the probab ility of having FSGS in AA but not non-AA patients (P=0.04). Five-year actu arial renal survival of FSGS was worse in AA (8%) than in non-AA patients ( 31%) (P=0.01). These data suggest an increased risk and worse outcome of FS GS in AA compared with non-AA children.