En: Brenner BM, editor. Madrid: Elsevier; The nephrotic syndrome: its incidence and implications for the community. Am J Dis Child ; 6 Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomized controlled trials.
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Retrospective analysis of clinical data and treatment of primary focal segmental glomerulosclerosis patients. Introduction: The aim of the study is to compare clinical data of primary focal segmental glomerulosclerosis patients with other data in the literature. In addition, initial immunosuppressive therapy steroid, calcineurin inhibitors responses are aimed to be compared with the results in the literature.
Methods: Forty seven patients, who were followed up for at least 12 months with primary focal segmental glomerulosclerosis as a result of kidney biopsy. Results of biochemical tests and treatment modalities were evaluated.
Results: The mean age of the 47 patients with primary focal segmental glomerulosclerosis was Twenty-one Thirteen patients Conclusion: We found the initial steroid treatment and calcineurin inhibitor treatment to be equally effective.
We thought that patients with steroid intolerance could be given calcineurin inhibitor in the first step, but if the cost is considered, the first option, such as the Kidney Disease Improving Global Outcomes recommendation, was again steroid. KEYWORDS: primary focal segmental glomerulosclerosis; immunosuppression; corticosteroid; calcineurin inhibitor; remission; proteinuria.
Asimismo, se busca comparar las respuestas de la terapia inmunosupresora inicial esteroides, inhibidores de la calcineurina con los resultados en las publicaciones citadas. Focal Segmental Glomerulosclerosis FSGS is the most frequent cause of renal failure among the primary glomerulonephritis. This retrospective study has been conducted on 47 primary FSGS patients, who had been diagnosed by renal biopsy and followed-up for at least 12 months.
This study aims to analyze the admission symptoms of primary FSGS patients and to determine the possible symptoms of admission. Besides, we intended to reveal the criteria other than the existing remission criteria. Finally, although KDIGO suggests CS therapy for initial treatment, we compared the treatment response rates of the participants that received CNI and steroids for initial treatment versus only steroids treatment group.
In short, we intended to analyze clinical data, therapy methods and immune-suppressive treatment response of the primary FSGS patients and compare data obtained with the findings in the literature. Written informed consent was obtained from all participants. All patients were included in the study after signing informed consent forms. The study was performed in accordance with Declaration of Helsinki. Permission from the Ethical Commission Board of Data on patient characteristics were obtained from the routine tests that were administrated during diagnosis, treatment and follow-up and data obtained from the renal biopsies.
Reduction of proteinuria to 0. When comparing the treatment responses, we presented the sum of the number of patients with partial and complete remission as the total number of patients with remission since the number of participants of our study was limited.
CS treatment was continued at least for 6 months as maximized in the first 16 weeks. Statistical analysis. Data distribution was analyzed with Kolmogorov Smirnov test. Forty seven patients with primary FSGS were included in the study.
Demographic characteristics of the patients can be seen in Table 1. Mean age of the participants was Fifteen patients Besides, 25 patients Mean duration of disease was 3. The laboratory features of the patients at the time of biopsy can be seen in Table 1.
Creatinine was 1. Analysis of the histopathological characteristics of the renal biopsies of the primary FSGS can be seen in Table 2. Table 1. Demographic data and laboratory characteristics of patients at diagnosis time. Table 2. Histopathological features of renal biopsy of patients with primary FSGS. The average glomerular number was The interstitial fibrosis ratio of CNI group was Tubular atrophy in CNI group was Table 4. Twenty one patients Six Table 3.
Treatment of patients with primary FSGS. Demographic data of patients with initial immunosuppressive treatment and comparison with laboratory features month 0. Eleven patients had diabetes and 6 patients were given CNI as an initial treatment.
These 6 patients had risk factors other than diabetes. Five patients with diabetes, whose diabetes were regulated, were given CS treatment as an initial treatment.
Table 5. Comparison of the initial immunosuppressive treatment options with the 6 th month laboratory characteristics of patients. Table 7 shows the treatment responses of the two groups with different initial treatment for the 6 th and the 12 th months.
The sum of the patients with partial and complete remission was shown as the number and the percentage of patients with remission in the table. For both groups, there were no patients with complete remission in the 6 th month. Table 6.
Comparison of the initial immunosuppressive treatment options with the 12 th month laboratory features. Table 7. Comparison of immunosuppressive therapies for response evaluation. Given the number of patients with remission was low in both groups, we compared the sum of the patients that achieved partial and complete remission. Figure 1A. Figure 1B. The patients who had remission had statistically significantly lower ratio of interstitial fibrosis At the end of the first year, 33 of the 47 patients achieved remission whereas the remaining 14 patients did not achieve remission.
Regarding the responses, we found that only 1 patient 2. On the 12th month, we found that 6 patients Table 8. Comparison of patients with FSGS with and without remission at the 0 th month laboratory features. FSGS is the most common histological finding of glomerular damage and is one of the most important reasons of nephrotic syndrome in adults and children. We evaluated clinical findings, therapy methods and responses of the patients to first-line immunosuppressive therapies, including steroid and CNI therapies.
Mean age of the 47 participants was For example, the study of Deegens et al. Histopathological characteristics of the renal biopsies of the primary FSGS patients in our study shows that average number of glomeruli was Interstitial fibrosis in FSGS is associated with poor renal survival.
However, 6 of the 19 patients received CNI and low dose CS without prior CS monotherapy because of uncontrolled DM 4 patients , osteoporosis 1 patient and psychiatric reasons 1 patient. The study of Huang et al. However, the risk of nephrotoxicity is higher for the patients that have high serum creatinine and sclerotic glomeruli prior to treatment and that receive cyclosporin more than 5.
Similar to our study, in various studies, medications other than steroids were used as first-line immunosuppressive therapy. In retrospective study of Goumenos et al. CS monotherapy led to remission in Goumenos et al. Our study compared the demographic age and gender , laboratory creatinine, albumin, hematuria, etc. Six of 11 diabetic patients received CNI. The reason why CS was not given was not only diabetes. Patients with regulated diabetes were given CS.
We found no other statistically significant difference between the two groups. About Regarding the treatment responses, we found that 2. For the 12th month, At the end of one year, in our study, 27 of the 33 patients achieved partial and 6 patients achieved complete remission. Since the number of patients was low, we did not conduct statistical analysis for these patients.
The participants were followed-up for an average period of 64 months. Baseline serum creatinine levels and remission achievement rate have been important indicators of ESRD. Prognostic factors in FSGS include proteinuria and creatinine levels, histopathological characteristics of biopsy, and more importantly, treatment response. This study aimed to compare the clinical and treatment findings of FSGS with the findings in the literature.
The study has two main limitations: firstly, it was a retrospective study, and secondly, this study has been conducted at a single center with a small number of patients.
Glomeruloesclerosis focal y segmentaria
Retrospective analysis of clinical data and treatment of primary focal segmental glomerulosclerosis patients. Introduction: The aim of the study is to compare clinical data of primary focal segmental glomerulosclerosis patients with other data in the literature. In addition, initial immunosuppressive therapy steroid, calcineurin inhibitors responses are aimed to be compared with the results in the literature. Methods: Forty seven patients, who were followed up for at least 12 months with primary focal segmental glomerulosclerosis as a result of kidney biopsy. Results of biochemical tests and treatment modalities were evaluated. Results: The mean age of the 47 patients with primary focal segmental glomerulosclerosis was
2009, Número 1
Consultar otras publicaciones de la S. David Arroyo 1 , Carmen Mon 2. Hospital Universitario Severo Ochoa. Hay factores de agresividad propios del germen. Puede haber semilunas extracapilares, pero suelen ser escasas  . Los vasos extraglomerulares no suelen mostrar alteraciones.
Abstract A half of the patients with nephrotic syndrome caused by primary FGS are resistant to steroid treatment. In steroid-resistant patients, the best therapeutic option are calcineurin inhibitors. In patients with resistance to calcineurin inhibitors, there is no treatment option capable of modifying the clinical course of the disease, supported by properly designed clinical trials, although observational studies have suggested the potential usefulness of mycophenolate, sirolimus, rituximab, apheresis or galactose as therapeutic options. In patients with steroid and cyclosporine — resistant idiopathic FGS it would be appropriate to conduct a systematic analysis including. Currently, there are multiple studies trying to identify the pathogenic mechanisms causing podocyte injury and there are ongoing studies to analyze the effectiveness of drugs such as adalimumab, fresolimumab, rosiglitazone, galactose or ACTH.
Treatment of idiopathic focal segmental glomerulosclerosis : options in the event of resistance to corticosteroids and calcineurin inhibitors. ISSN Half of patients with nephrotic syndrome caused by primary focal segmental glomerulosclerosis FSGS have resistance to treatment with steroids. In the case of corticosteroid resistance, the best evidence-based option has classically been treatment with calcineurin inhibitors, although recent studies indicate that mycophenolate may have similar efficacy.