Develop and Validate a Risk Score in Predicting Renal Failure in Focal Segmental Glomerulosclerosis

Area of Science:

• Nephrology
• Clinical Prediction Modeling
• Glomerular Diseases

Background:

• Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage kidney disease (ESKD).
• Accurate prediction of ESKD progression in FSGS patients is crucial for timely intervention.
• Existing risk stratification tools may not fully capture the complexity of FSGS pathophysiology.

Purpose of the Study:

• To develop and validate a novel risk score (RS) for predicting ESKD in patients diagnosed with FSGS.
• To identify key clinicopathological predictors of ESKD in the FSGS population.
• To assess the performance of the developed RS in forecasting 5-year ESKD risk.

Main Methods:

• A cohort of 359 patients with biopsy-proven FSGS was enrolled and stratified into two groups.
• Multivariate Cox regression analyses were employed to establish two distinct risk scores (RS 1 and RS 2) based on clinicopathological variables.
• Cross-validation between the two groups was performed to assess the predictive accuracy (c-statistic) of the developed risk scores.

Main Results:

• Two risk scores, RS 1 and RS 2, were developed, each incorporating five key predictors including estimated glomerular filtration rate (eGFR), urine protein, mean arterial pressure (MAP), immunoglobulin G (IgG) levels, and tubulointerstitial lesion (TIL) score.
• RS 1 demonstrated strong predictive performance for 5-year ESKD risk, with c-statistics of 0.86 in group 1 and 0.91 in group 2.
• Kaplan-Meier survival analysis indicated that increasing risk levels, as determined by the RS, correlated with a higher incidence of ESKD progression.

Conclusions:

• A validated predictive model incorporating clinicopathological features has been successfully developed for ESKD prediction in FSGS patients.
• The developed risk score offers a valuable tool for stratifying FSGS patients based on their risk of progressing to ESKD.
• This risk score can potentially guide clinical decision-making and personalize patient management strategies for FSGS.