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NDT Advance Access originally published online on April 18, 2007
Nephrology Dialysis Transplantation 2007 22(8):2201-2207; doi:10.1093/ndt/gfm188
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Focal segmental glomerulosclerosis is not a sufficient predictor of renal outcome in patients with membranous nephropathy

Saskia F. Heeringa1, Amanda J. W. Branten1, Jeroen K. J. Deegens1, Eric Steenbergen2 and Jack F. M. Wetzels1

1Department of Nephrology and 2Department of Pathology, Radboud University Nijmegen Medical Centre, The Netherlands

Correspondence and offprint requests to: S. F. Heeringa, MD, Department of Nephrology 464, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Email: sf.heeringa{at}gmail.com



  Abstract

Background. The course of idiopathic membranous nephropathy (iMN) is variable in untreated patients. Accurate prediction of renal outcome would allow optimal treatment decisions. We demonstrated that urinary ß2-microglobulin (ß2M) predicted prognosis in iMN with high sensitivity and specificity. It has been suggested that focal segmental glomerulosclerosis (FSGS) is a discriminative parameter with independent prognostic value.

Methods. We selected patients with iMN biopsied between 1988 and 2002. Biopsies were analysed for the presence of FSGS, interstitial fibrosis and vascular lesions. Serum creatinine, creatinine clearance, proteinuria and blood pressure were recorded at baseline. Outcome variables included remission of proteinuria, renal death (RD) defined as serum creatinine >135 µmol/l or increase of serum creatinine of >50%, or end-stage renal disease (ESRD). In a subgroup of patients, urinary ß2-microglobulin (ß2M) was measured.

Results. We included 53 patients (33M, 20F). Mean age was 51 years, serum creatinine 99 µmol/l, and proteinuria 7.0 g/10 mmol creatinine. FSGS was present in 22 patients. These patients were characterized by a higher serum creatinine at time of biopsy (P = 0.035), more severe interstitial fibrosis (P = 0.001) and higher stage of membranous nephropathy (P = 0.001). During follow-up 24 patients developed RD, almost equally distributed between patients with and without FSGS. Renal survival was numerically, but not significantly, lower in patients with FSGS. In Cox proportional hazard analysis, only serum creatinine at the time of biopsy was an independent predictor of RD or ESRD (P < 0.001). In patients with known urinary ß2M, there was no significant correlation with FSGS score (P = 0.174).

Conclusion. FSGS is not an accurate prognostic marker in iMN. Histological scoring of FSGS is inferior to measurement of urinary proteins in predicting renal outcome in iMN.

Keywords: focal segmental glomerulosclerosis (FSGS); idiopathic membranous nephropathy (iMN); prognosis

Received for publication: 15. 7.06
Accepted in revised form: 9. 3.07


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