What is the clinical course of Focal segmental glomerulosclerosis?
Primary FSGS has a variable course. Clinical factors such as the degree of proteinuria at disease presentation, the amount of interstitial fibrosis and tubular atrophy noted on kidney biopsy,
proteinuria reduction in response to therapy, and collapsing histologic variant are considered prognostic factors for kidney survival. Spontaneous remission is reported in less than 5% of patients with primary FSGS.
Therapy may result in complete proteinuria remission (normal urinary protein excretion), partial remission, or resistance to therapy. Patients with complete remission have an expected 90% 10-year kidney survival.
For patients with proteinuria in the nephrotic range that is resistant to treatment, the 10-year kidney survival is approximately 50%. Patients with partial proteinuria remission have intermediate 10-year kidney survival. Patients with high-risk APOL1 genotype have a poorer kidney survival relative to low-risk genotype. As in many kidney diseases, patients who present with an elevated serum creatinine have a poorer prognosis.