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The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis: A Clinicopathologic Study

Published:October 27, 2017DOI:https://doi.org/10.1016/j.mayocp.2017.09.011

      Abstract

      Objectives

      To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS.

      Patients and Methods

      Olmsted County adult residents with native kidney biopsy from January 1, 1994, through December 31, 2013, and FSGS as the only glomerulopathy were identified. The clinical and pathologic characterstics of primary and secondary FSGS were described and compared, and incidence rates were calculated.

      Results

      Of 370 adults biopsied, 281 had glomerular diseases, of which 46 (16%) had FSGS. From 1994-2003 to 2004-2013, there were significant increases in kidney biopsy rates (14.7 [95% CI, 12.1-17.3] vs 22.9 [95% CI, 20.0-25.7] per 100,000 person-years, 17% increase per 5 years; P<.001) and total FSGS rates (1.4 [95% CI, 0.6-2.2] vs 3.2 [95% CI, 2.1-4.3] per 100,000 person-years, 41% increase per 5 years; P=.02). Compared with patients with limited foot process effacement (<80%), patients with diffuse effacement (≥80%) without an identifiable cause had lower serum albumin levels (P<.001), had higher proteinuria (P<.001), and were more likely to have nephrotic syndrome (100% vs 4%; P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3 of 12 patients (25%) during 1994-2003 and 9 of 34 (26%) during 2004-2013.

      Conclusion

      Although the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.

      Abbreviations and Acronyms:

      ACEi (angiotensin-converting enzyme inhibitor), ARB (angiotensin receptor blocker), BMI (body mass index), CKD (chronic kidney disease), DBP (diastolic blood pressure), eGFR (estimated glomerular filtration rate), ESRD (end-stage renal disease), FPE (foot process effacement), FSGS (focal segmental glomerulosclerosis), IQR (interquartile range), NS (nephrotic syndrome), RAAS (renin-angiotensin-aldosterone system), SBP (systolic blood pressure)
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