Focal segmental glomerulosclerosis in African Americans: Effects of steroids and angiotensin converting enzyme inhibitors

Background: Focal segmental glomerulosclerosis (FSGS) is a common primary g lomerulopathy in African Americans. In this report, we present data on 40 A frican American patients with FSGS from our medical center. Methods: Patien ts were identified from a review of all charts seen in our conservative man agement renal clinic in 1996, a review of renal biopsy rolls (1994-1998), a nd a review of patients entering the end-stage renal disease (ESRD) program with a primary diagnosis of FSGS (1993- 1997). Charts were reviewed for de mographic, biopsy, and treatment data. Patients who were observed for at le ast 4 months (range, 4-125 months) were included. ESRD was used as the prim ary endpoint (n = 12). Data were analyzed using univariate and multivariate Cox hazards and Kaplan-Meier survival analysis. Twenty-four patients were treated with angiotensin-converting enzyme (ACE) inhibitors. Similarly, 24 patients were treated with corticosteroids for a mean of 8.75 +/- 2.6 month s and a total dose of 9.3 +/- 2.2 g. Results: On univariate analysis, facto rs found to besignificant determinants for reaching ESRD were the initial c reatinine (P = 0.0001), interstitial fibrosis (P = 0.032), the percentage o f globally sclerosed glomeruli (P = 0.0018), and the mean arterial blood pr essure over the course of follow-up (P = 0.05). Neither the ACE inhibitors nor the corticosteroids had a significant impact on reaching ESRD. The pati ents reaching ESRD (n = 12)were analyzed separately. The mean time from bio psy to ESRD was 24.7 +/- 9.8 months. ACE inhibitors prolonged renal surviva l (P = 0.023), but steroids did not. Initial creatinine was the only factor found to be a significant determinant for ESRD. Conclusions:We conclude th at FSGS is common in African Americans. Early diagnosis and blood pressure control are important, but the beneficial effects of steroids and ACE inhib itors in this population are still unclear.