Patterns of Primary Focal Segmental Glomerulosclerosis (FSGS) in Adults Treated in a Dakar Single Center: About 58 Cases

Abstract

Introduction: The evolution of primary FSGS is often marked by the occurrence of relapse and corticosteroid resistance and the therapeutic options are numerous and have limited effectiveness. The objective of our study was to assess our practice in this lesion. Patients and Methods: We carried out a retrospective study of patients treated for primary FSGS the period January 1, 2010 to September 30, 2018. The clinical pathological, therapeutic and evolutive characteristics were studied. Results: Fifty-eight patients were included in the study. The average age was 30.74 ± 11.35 years and the sex ratio (M/F) was 2.41. Edema was found in 86.2% and hypertension in 37.9%. The average creatinine was 20.17 ± 16.06 mg/l and the average GFR according to MDRD was 82.43 ± 69.06 ml/min/1.73 m 2 . The average albumin level was 15.11 ± 5.78 g/l and the 24-hour proteinuria was 7.8 ± 3.79 g/24 h. Nephrotic syndrome was the main indication for renal biopsy in 84.48% and the classic form of FSGS was found in 90.9%. The average initial corticosteroid dose was 62.68 ± 10.04 mg/d and the average duration of regression was 11.78 ± 7.40 months. Forty-five patients (77.6%) were corticosensitive (27.6% complete remission and 50% partial remission). Corticosteroid resistance was observed in 19% and corticosteroid dependence in 11.1%. The proportion of relapse was 33.3% within an average of 15.4 ± 9.1 months. Cyclosporine was no longer prescribed as a second-line treatment in 8 patients. Infectious complications were more found in 19%. Two patients had progressed to ESRD and we noted 2 death cases. The male gender was correlated with the occurrence of a relapse. However, the impact of certain factors such as hypertension, proteinuria, hematuria and GFR level has not been demonstrated. Conclusion: The evolution of primary FSGS is unpredictable, often

Adult primary glomerular diseases due to podocytopathies: a single center experience on patient characteristics, treatment and outcomes

“…The age at diagnosis ranged from 20 to 87 years. Consistent with the findings of previous studies, the current study found significant male dominance 11,[18][19][20] . One retrospective study by Stirling et al, using patient data from five different UK centers, showed that the mean age was similar to that in our study 20 .…”

“…In our study, the mean proteinuria level was found to be in the nephrotic range, at 8.5±4.0 g/day. The rates of hypertension (37%) 12,18 and microscopic hematuria (40.7%) 12 were similar to those in previous studies. In According to the Kidney Disease Improving Global Outcomes (KDIGO) recommendations, patients with MCD and primary FSGS can be treated with corticosteroids daily or every other day, and if there are no contraindications, corticosteroids are recommended as first-line therapy 7,23 .…”