Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center
Treatment of focal segmental glomerulosclerosis (FSGS) is frustrating, especially for steroid-resistant FSGS. Different immunosuppressive agents have been used with inconsistent outcome. We analyzed the data in our FSGS patients who, in addition to steroid, were treated with cyclosporine (CYA), cycl...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Saudi Journal of Kidney Diseases and Transplantation |
| Online Access: | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2022;volume=33;issue=1;spage=111;epage=121;aulast=Qureshi |
| _version_ | 1797902850980839424 |
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| author | Ruqaya Qureshi Kiran Nasir Salman Imtiaz Murtaza F Dhrolia Aasim Ahmad Bina Salman |
| author_facet | Ruqaya Qureshi Kiran Nasir Salman Imtiaz Murtaza F Dhrolia Aasim Ahmad Bina Salman |
| author_sort | Ruqaya Qureshi |
| collection | DOAJ |
| description | Treatment of focal segmental glomerulosclerosis (FSGS) is frustrating, especially for steroid-resistant FSGS. Different immunosuppressive agents have been used with inconsistent outcome. We analyzed the data in our FSGS patients who, in addition to steroid, were treated with cyclosporine (CYA), cyclophosphamide (CYP), and mycophenolate mofetil (MMF) along with the long-term follow-up. This is a retrospective analysis of 113 patients diagnosed to have FSGS with 11 years’ follow-up carried out at The Kidney Center Post Graduate Training institute. Among 113 patients, 51.3% were male with a mean age of 34.4 ± 11.8 standard deviation. Patients who achieved complete remission with steroid alone and steroid with combination of CYA, CYP, and MMF were 38 (26%), 19 (16.8%), and six (5.3%), respectively, similarly those who got partial remission were three (3.6%), five (4.4%), three (2.6%), and eight (7.0%), respectively. The factors which affected the outcome were serum creatinine (SCr), tubulointerstitial fibrosis (TIF), and the treatment. In adjusted analysis, increase in 1 mg of SCr reduces the patient recovery by 56%, while the absence of TIF increases recovery by 80.75%. Taking steroid as reference category, steroid + CYA found 2.03 times more effective as compared with steroid alone. Seven patients developed end-stage renal disease (ESRD) and three died due to disease during the follow-up. CYA comes out as the most effective treatment for steroid-resistant FSGS followed by MMF and CYP. The long-term outcome of all modalities is the same in terms of mortality and developing ESRD. The degree of TIF and renal failure has strong influence on the course of the disease. |
| first_indexed | 2024-04-10T09:23:52Z |
| format | Article |
| id | doaj.art-f76a781f9a9b42678786df81f7303bdf |
| institution | Directory Open Access Journal |
| issn | 1319-2442 |
| language | English |
| last_indexed | 2024-04-10T09:23:52Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Kidney Diseases and Transplantation |
| spelling | doaj.art-f76a781f9a9b42678786df81f7303bdf2023-02-20T07:28:24ZengWolters Kluwer Medknow PublicationsSaudi Journal of Kidney Diseases and Transplantation1319-24422022-01-0133111112110.4103/1319-2442.367804Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single CenterRuqaya QureshiKiran NasirSalman ImtiazMurtaza F DhroliaAasim AhmadBina SalmanTreatment of focal segmental glomerulosclerosis (FSGS) is frustrating, especially for steroid-resistant FSGS. Different immunosuppressive agents have been used with inconsistent outcome. We analyzed the data in our FSGS patients who, in addition to steroid, were treated with cyclosporine (CYA), cyclophosphamide (CYP), and mycophenolate mofetil (MMF) along with the long-term follow-up. This is a retrospective analysis of 113 patients diagnosed to have FSGS with 11 years’ follow-up carried out at The Kidney Center Post Graduate Training institute. Among 113 patients, 51.3% were male with a mean age of 34.4 ± 11.8 standard deviation. Patients who achieved complete remission with steroid alone and steroid with combination of CYA, CYP, and MMF were 38 (26%), 19 (16.8%), and six (5.3%), respectively, similarly those who got partial remission were three (3.6%), five (4.4%), three (2.6%), and eight (7.0%), respectively. The factors which affected the outcome were serum creatinine (SCr), tubulointerstitial fibrosis (TIF), and the treatment. In adjusted analysis, increase in 1 mg of SCr reduces the patient recovery by 56%, while the absence of TIF increases recovery by 80.75%. Taking steroid as reference category, steroid + CYA found 2.03 times more effective as compared with steroid alone. Seven patients developed end-stage renal disease (ESRD) and three died due to disease during the follow-up. CYA comes out as the most effective treatment for steroid-resistant FSGS followed by MMF and CYP. The long-term outcome of all modalities is the same in terms of mortality and developing ESRD. The degree of TIF and renal failure has strong influence on the course of the disease.http://www.sjkdt.org/article.asp?issn=1319-2442;year=2022;volume=33;issue=1;spage=111;epage=121;aulast=Qureshi |
| spellingShingle | Ruqaya Qureshi Kiran Nasir Salman Imtiaz Murtaza F Dhrolia Aasim Ahmad Bina Salman Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center Saudi Journal of Kidney Diseases and Transplantation |
| title | Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center |
| title_full | Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center |
| title_fullStr | Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center |
| title_full_unstemmed | Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center |
| title_short | Outcomes of Different Immunosuppressive Regimen in Adult Biopsy Proven Idiopathic Focal Segmental Glomerulosclerosis: A Retrospective Analysis at a Single Center |
| title_sort | outcomes of different immunosuppressive regimen in adult biopsy proven idiopathic focal segmental glomerulosclerosis a retrospective analysis at a single center |
| url | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2022;volume=33;issue=1;spage=111;epage=121;aulast=Qureshi |
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