Focal segmental glomerulosclerosis in renal allografts with chronic nephropathy: Implications for graft survival

De novo focal segmental glomerulosclerosis (FSGS) in renal allografts most often is diagnosed in association with chronic allograft nephropathy (CN), In this study, we assessed the clinical and pathological variables that cor relate with the presence of de novo FSGS and the implications of FSGS for t he survival of grafts with CN. The study population included 293 renal allo graft recipients (52 living related donor, 241 cadaveric donor) diagnosed w ith CN by biopsy more than 6 months after transplantation. Patients with re current FSGS or FSGS associated with other glomerulopathies were excluded. FSGS was present in 87 patients with CN (30%), FSGS was diagnosed more comm only in the following groups of patients: young (P = 0.04), black (P = 0.02 ), and those with elevated serum cholesterol levels (P = 0.002) and/or high -grade proteinuria (P < 0.0001, all univariate analysis). FSGS was diagnose d later after transplantation than CN without FSGS (P < 0.0001), and FSGS c orrelated with the presence of arteriolar hyalinosis in the biopsy specimen (P = 0.04). Compared with CN without FSGS, FSGS was associated with signif icantly worse death-censored graft survival (P = 0.008, univariate Cox), In addition, when we analyzed all patients with CN, graft survival correlated by multivariate analysis with the following parameters: serum creatinine l evel (P < 0.0001) and proteinuria (P = 0.004) at the time of diagnosis, pre sence of FSGS (P = 0.03), and degree of interstitial fibrosis and tubular a trophy (CN score; P < 0.0001, Cox). Of interest, the use of lipid-reducing agents was also associated with improved graft survival in patients with CN (P = 0.0002, univariate Cox), although total lipid levels were not signifi cantly less in patients receiving these drugs, In conclusion, de novo FSGS presents late after transplantation and in association with arteriolar hyal inosis, suggesting these lesions may be related to chronic cyclosporine tox icity. In CN, the presence of FSGS and the severity of interstitial fibrosi s are negative independent predictors of graft survival, The possible relat ionship between lipid-reducing agents and graft survival clearly needs to b e examined carefully in future studies, (C) 1999 by the National Kidney Fou ndation, inc.