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Focal segmental glomerulosclerosis in adult African Americans
A A Bakir1, D S Share, P S Levy
1Division of Nephrology, Cook Country Hospital, Chicago, Illinois 60612, USA.
Clinical Nephrology
|November 1, 1996
Summary
Idiopathic focal segmental glomerulosclerosis (FSGS) in African Americans shows a 33% rate of end-stage renal failure within five years. Early elevated creatinine predicts poorer outcomes, suggesting a potentially worse long-term prognosis compared to other groups.
Area of Science:
- Nephrology
- Glomerular Diseases
- Renal Pathology
Background:
- Idiopathic focal segmental glomerulosclerosis (FSGS) is a leading cause of primary glomerulopathy in adult African Americans.
- Previous research established FSGS as the most common non-proliferative primary glomerulopathy in this demographic.
Purpose of the Study:
- To evaluate the long-term outcomes of treated FSGS in adult African Americans.
- To identify predictors of renal failure and assess treatment efficacy.
Main Methods:
- Retrospective analysis of 15 adult African American patients with FSGS.
- Treatment included prednisone, with some patients receiving cyclophosphamide or enalapril.
- Follow-up extended over five years, monitoring renal function, proteinuria, and blood pressure.
Main Results:
- 33% of patients developed end-stage renal failure (ESRF) within five years; cumulative renal survival was 93% at five years but 26% at eight years.
- Elevated serum creatinine at entry was associated with a higher risk of ESRF (p=0.09).
- While short-term outcomes were comparable to non-African Americans, long-term prognosis appeared poorer. Enalapril did not significantly alter the disease course.
Conclusions:
- Adult African Americans with treated FSGS face a potentially poorer long-term renal prognosis.
- Initial elevated serum creatinine is a significant predictor of adverse renal outcomes.
- Further randomized controlled trials are needed to determine the role of ACE inhibitors like enalapril in FSGS management.