Clinicopathological features and medium-term outcomes of histologic variants of primary focal segmental glomerulosclerosis in adults: A retrospective study

Table 1 Demographic, clinical, and laboratory parameters at the time of presentation of the three most common focal segmental glomerulosclerosis morphologic variants

Parameters	All patients (n = 343)	NOS (n = 185)	TIP (n = 100)	COL (n = 58)	P value
Age (yr), mean ± SD	29.2 ± 12.0	29.3 ± 12.4	28.6 ± 11.2	30.1 ± 12.4	0.733
Male to female ratio	2.1:1	2.0:1	2.8:1	1.4:1	0.133
Systolic BP (mmHg), mean ± SD	128.8 ± 8.0	128.9 ± 18.9	127.5 ± 16.2	130.6 ± 18.9	0.575
Diastolic BP (mmHg), mean ± SD	84.6 ± 12.6	84.8 ± 12.0	82.5 ± 12.5	87.6 ± 14.1	0.045
Initial proteinuria (mg/24 h), IQR	3774 (2216-5900)	3602.5 (2125-5890)	4250 (2535 -6530)	3900 (2218-4800)	0.418
Serum albumin (g/dL), mean ± SD	2.0 ± 1.2	2.0 ± 1.3	2.2 ± 0.9	2.1 ± 1.1	0.863
Serum creatinine (mg/dL), mean ± SD	1.1 ± 0.9	1.1 ± 0.7	1.1 ± 1.1	1.2 ± 0.7	0.830
Initial eGFR (mL/min/1.73 m2), IQR	83.9 (55.9-127.4)	85.4 (57.8-128.3)	82.3 (59.5-125.9)	69.1 (41.9-127.3)	0.463
Elevated serum creatinine, n (%)	82 (23.9)	43 (52.4)	20 (24.4)	19 (23.2)	0.607
Males (> 1.4 mg/dL), n (%)	58 (70.7)	29 (67.4)	17 (85.0)	12 (63.2)	0.257
Females (> 1.2 mg/dL), n (%)	24 (29.3)	14 (32.6)	3 (15.0)	7 (36.8)
Follow-up duration (month), mean ± SD	36.5 ± 29.2	39.1 ± 31.5	31.4 ± 24.9	37.0 ± 27.7	0.114
Total steroid dose (mg), mean ± SD	4282.1 ± 1943.2	4266.9 ± 1884.1	4366.7 ± 2067.8	4186.1 ± 1935.3	0.858
Duration of steroid treatment (wk), IQR	18 (14-23)	18 (14-23)	19 (15-23.5)	17 (13.5-20.5)	0.359
Total CsA dose (mg) mean ± SD	27118.6 ± 24904.8	30002.4 ± 26537.5	25539.4 ± 28050.2	21549.7 ± 1657.7	0.447
Duration of CsA treatment (wk), IQR	16 (6.8-46.0)	16 (8.0-54.0)	17 (5.0-69.0)	12 (4.0-28.0)	0.727

NOS: Not otherwise specified; TIP: Tip; COL: Collapsing; CsA: Cyclosporine; BP: Blood pressure; eGFR: Estimated glomerular filtration rate; IQR: Interquartile range.

Table 2 Histopathology findings on kidney biopsies in the three most common focal segmental glomerulosclerosis morphologic variants

Histopathology	All patients (n = 343)	NOS (n = 185)	TIP (n = 100)	COL (n = 58)	P value
No. of glomeruli, mean ± SD	17.3 ± 8.4	16.4 ± 8.7	18.1 ± 6.8	17.3 ± 9.7	0.370
No. of glomeruli with global sclerosis, mean ± SD	2.6 ± 2.2	2.1 ± 2.3	2.0 ± 0.8	3.6 ± 2.5	0.001
No. of glomeruli with segmental collapse, mean ± SD	2.9 ± 2.7	2.4 ± 1.8	2.6 ± 2.8	13.7 ± 3.3	0.050
Tubular atrophy, mild, n (%)	175/201 (87.1)	91 (52.0)	49 (28.0)	35 (20.0)	< 0.001
Tubular atrophy, moderate, n (%)	26/201 (12.9)	9 (36.6)	1 (3.8)	16(61.5)
Fibrointimal thickening of arteries, mild, n (%)	25/32 (98.1)	13 (52.0)	7 (28.0)	5 (20.0)	0.413
Fibrointimal thickening of arteries, moderate, n (%)	7/32 (21.9)	5 (27.8)	2 (22.2)	0 (0.0)

NOS: Not otherwise specified; TIP: Tip; COL: Collapsing.

Table 3 Responses to treatment and final clinical outcomes of focal segmental glomerulosclerosis morphologic variants in patients who received treatment, n (%)

Outcomes	All patients (n = 302)	NOS (n = 160)	TIP (n = 89)	COL (n = 53)	P value
Complete remission	84 (27.8)	40 (25.0)	42 (47.1)	2 (3.7)	< 0.001
Partial remission	49 (16.2)	27 (16.8)	11 (12.4)	11 (20.8)	0.005
No remission	169 (55.9)	93 (58.1)	36 (40.4)	40 (75.5)	< 0.001
Relapse	40 (13.2)	27 (16.9)	9 (10.1)	4 (7.5)	0.029
Final eGFR (mL/min/1.73 m2), mean ± SD	92.1 ± 57.7	94.1 ± 59.1	110.3 ± 52.8	60.0 ± 46.9	< 0.001
Doubling of serum creatinine at last follow-up	30 (9.9)	16 (10.0)	1 (1.1)	13 (24..5)	< 0.001
Kidney failure	36 (11.19)	13 (8.1)	0 (0.0)	23 (43.3)	< 0.001
Hemodialysis	18 (5.9)	5 (3.1)	0 (0.0)	13(24.5)	< 0.001
Expired	4 (1.3)	3 (1.8)	0 (0.0)	1 (1.8)	0.429

NOS: Not otherwise specified; TIP: Tip; COL: Collapsing; eGFR: Estimated glomerular filtration rate.