Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Mar 25, 2024; 13(1): 88028
Published online Mar 25, 2024. doi: 10.5527/wjn.v13.i1.88028
Clinicopathological features and medium-term outcomes of histologic variants of primary focal segmental glomerulosclerosis in adults: A retrospective study
Nazarul Hassan Jafry, Shumaila Manan, Rahma Rashid, Muhammed Mubarak
Nazarul Hassan Jafry, Shumaila Manan, Department of Nephrology, Sindh Institute of Urology and Transplantation, Sindh, Karachi 74200, Pakistan
Rahma Rashid, Muhammed Mubarak, Department of Pathology, Sindh Institute of Urology and Transplantation, Sindh, Karachi 74200, Pakistan
Author contributions: Jafry NH and Mubarak M conceived and designed the study; Jafry NH, Manan S, Rashid R, and Mubarak M performed the research; all four participated in primary and final drafting; all read and approved the final manuscript; all four authors contributed significantly and equally to preparation of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Sindh Institute of Urology and Transplantation.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Data are available from the first author and can be shared on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammed Mubarak, MD, Professor, Department of Pathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, DFMC, Sindh, Karachi 74200, Pakistan. drmubaraksiut@yahoo.com
Received: September 6, 2023
Peer-review started: September 6, 2023
First decision: November 21, 2023
Revised: November 30, 2023
Accepted: January 11, 2024
Article in press: January 11, 2024
Published online: March 25, 2024
Processing time: 197 Days and 14.7 Hours
ARTICLE HIGHLIGHTS
Research background

The classification of focal segmental glomerulosclerosis (FSGS) is controversial and challenging. There is still a lack of a unified and consensus-based approach to classify this disease, which will be both practical and clinically useful.

Research motivation

This study addressed the clinical utility of the morphological classification of FSGS in real-world scenarios. We aimed to investigate the therapeutic and prognostic significance of the morphological variants of FSGS in a large cohort of adult patients.

Research objectives

This study aimed to determine the relative prevalence, clinicopathologic presentations, and outcomes of the morphological variants of FSGS in a large cohort of adult patients at a single center in Pakistan.

Research methods

This retrospective study included all consecutive adults (≥ 16 years) with biopsy-proven primary FSGS from January 1995 to December 2017. Studied subjects were treated uniformly with steroids and cyclosporine. The response rates and kidney outcomes were compared between histological variants using appropriate statistical tests. Data were analyzed using SPSS version 22.0. A P-value ≤ 0.05 was considered statistically significant.

Research results

The not otherwise specified (NOS) variant was the most common, being found in 185 (53.9%) patients, followed by the TIP variant in 100 (29.1%) patients. Collapsing (COL), cellular, and perihilar variants were seen in 58 (16.9%), 6 (1.5%), and 3 (0.7%) patients, respectively. The response rates were highest in patients with the TIP variant and lowest in those with the COL variant. Kidney outcomes were best in patients with the TIP variant and worst in those with the COL variant. The NOS variant was intermediate.

Research conclusions

The morphological variants of FSGS are relevant and should be utilized to inform treatment and prognosis in individual patients. Combining these with other clinicopathological features to refine their predictive value needs to be investigated in future studies.

Research perspectives

A holistic approach to disease categorization needs to be developed, which is practical and clinical-friendly.