Can prolonged treatment improve the prognosis in adults with focal segmental glomerulosclerosis?

Eighty nephrotic adults with focal segmental glomerulosclerosis (FSGS) and plasma creatinine lower than 3 mg/dL were given corticosteroids (53 patient s) or immunosuppressive agents (27 patients) for a median of 16 and 75 week s, respectively. Forty-two patients responded with complete remission (29 p atients, 36%) or partial remission (13 patients, 16%). Twenty-six patients who did not respond were treated again. Two patients obtained complete remi ssion and 13 partial remission. The probability of remission was associated with treatment with corticosteroids (P = 0.0001; RR, 3.93; 95% CI, 2.00 to 7.72), absence of arterial hypertension (P = 0.0023; RR, 2.59; 95% CI, 1.4 1 to 4.79), and a percentage of hyaline glomeruli tower than 5% (P = 0.0152 ; RR, 2.04; 95% CI, 1.15 to 3.64). The probability of being alive at 110 mo nths without doubting of plasma creatinine was 69%. The risk of renal insuf ficiency was correlated with mesangial proliferation (P = 0.0025; RR, 5.50; 95% CI, 1.82 to 16.60) and with interstitial fibrosis (P = 0.0231; RR, 4.4 4; 95% CI, 1.23 to 16.08) at initial biopsy. Considering partial or complet e remission as a time-dependent variable, only the lack of remission (P = 0 .0027; RR, 7.23; 95% CI, 1.98 to 26.33) and mesangial proliferation (P = 0. 0069; RR, 4.59; 95% CI, 1.52 to 13.88) were correlated with renal failure. Major side effects were observed in 11 patients (5 infections, 1 peptic ulc er, 2 diabetes, 3 neoplasias). This study shows that 70% of nephrotic adult s with FSGS may obtain complete or partial remission and maintain stable re nal function for about 10 years when given a prolonged therapy with cortico steroids or immunosuppressive drugs. (C) 1999 by the National Kidney Founda tion, Inc.