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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: October 27, 2017
Footnotes
Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Jennifer L. St Sauver, PhD). K.B. reports grant funding from National Institutes of Health (grant number R25-DK101405; Principal Investigator Michael F. Romero). A.R. reports a grant from NIH/NIDDK. F.C.F. and A.D.R. receive royalties from Up-to-Date.
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