1626 ANALYSIS OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN CHILDREN-IMPORTANCE OF CLINICAL PRESENTATION

Abstract

Focal segmental glomerulosclerosis (FSGS) may present with nephrotic syndrome (NS) or asymptomatic proteinuria (AP). We examined whether 16 children with FSGS and NS (Group A) had a worse outcome than 10 children with FSGS and AP (Group B). Initial clinical comparisons revealed: age (A-9.0±0.4 vs B-10.3 ± 1.4 yrs), U protein excretion (A-267±51.6 vs B-123.1±30.7 mg/m²/hr, P-0.05), U protein/U creatinine ratio (A-35.5±14.03 vs B-5.13±1.46 mg/mg, P-0.001), total serum protein (A-4.39±0.21 vs B-5.79±0.43gm/dl, P-0.01), serum albumin(A-1.85±0.19 vs B-3.34±0.3gm/dl, P-0.001) and serum cholesterol (A-390.7±24.6 vs B-267±36.5mg/dl, P-0.02). Diagnostic renal biopsies revealed more prominent mesangial proliferation in Group A, P-0.016, more tubular atrophy in Group B, P-0.007, and no difference in percent sclerotic glomeruli (A-21.8% vs B-24.2%). Patients were followed for A-39.6±13 vs B-37.6±6.0mos. 7 of 15 Group A patients have serum creatinine values (Scr)>1SD from mean for age and 3 of 15 have end stage renal disease. Only 2 of 10 Group B patients have (Scr)>1SD from mean for age and none have end stage renal disease. Scr in Group A were higher, 2.01±0.92mg/dl, than Group B, 0.71±0.08mg/dl, but were not statistically different, P<0.2, Nephrotic syndrome in FSGS appears to be a poor prognostic sign in children. These data support the concept that hyperfiltration of protein adversely affects renal function.

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