Partial Remission of Proteinuria as a Prognostic Indicator of the Outcome of the Focal Segmental Glomerulosclerosis in Children and Young Adults with Nephrotic Syndrome

Background: Focal segmental glomerulosclerosis is an important cause of chronic kidney disease in children and young adults. Steroid resistance is common and the severity and persistence of proteinuria are associated with progression toward advanced renal failure. The aim of the present study was to analyze the importance of partial remission of proteinuria on the outcome of children and young adults with FSGS.

Methods: 63 children and young adults with the idiopathic nephrotic syndrome and focal segmental glomerulosclerosis, not otherwise specified variant, were studied

Results: 29 patients were male and 34 female with a mean age of 10.0 ± 4.9 years. The follow-up was 73.4 + 72 months. The clinical course was characterized by sustained remission or remissions/ relapses in 28 patients (44.4%), partial remission in 8 (12.7%) and persistent nephrotic syndrome in 27 (42.9%). At final evaluation, 17 patients were hypertensive and 17 had a renal insufficiency of variable severity, although 9 evolved to advanced renal failure. Renal insufficiency at the end of the study was less frequent in patients with partial response than in patients with no-response, although this was higher than in those with complete remission (25.0%, 44.4%, and 10.7%, respectively). Partial remission was correlated with better renal survival than no-remission, although somewhat less impressive than in complete remission.

Conclusion: Therapeutic interventions to achieve reduction of the urinary protein excretion rate are very important in patients with focal segmental glomerulosclerosis.