Prognosis

The prognosis for patients with focal segmental glomerulosclerosis (FSGS) is extremely variable. Important prognostic factors are the amount of proteinuria; level of plasma creatinine; morphological subtype; and response to therapy.

About 50% of patients presenting with proteinuria >3 g/24 hours progress to end-stage renal failure within 5 to 10 years. Most patients reach end-stage renal failure within 5 years if proteinuria is >10 g/24 hours. By contrast, renal survival is over 80% after 10 years in patients with subnephrotic-range proteinuria.[58][59][60]

Approximately 50% of patients presenting with serum creatinine >99.13 micromol/L (1.3 mg/dL) progress to end-stage renal disease within 5 to 10 years.[58][59][60]

The morphological subtype identified on renal biopsy also provides useful prognostic information. The collapsing variant, the main variant seen in HIV-induced FSGS, is associated with a worse prognosis compared to other forms. The tip variant has a better prognosis in FSGS.[61][62]

In addition to the type, increased levels of fibrosis on the initial biopsy, including findings of interstitial fibrosis and glomerulosclerosis, are associated with a worse prognosis.

Attainment of complete or partial remission of proteinuria predicts a favourable outcome; <15% of patients attaining remission progress to end-stage renal failure.[38][58][59][60][63]

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