The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis: A Clinicopathologic Study

Musab S. Hommos, An S. De Vriese, Mariam P Alexander, Sanjeev M Sethi, Lisa Vaughan, Ladan Zand, Kharmen Bharucha, Nicola Lepori, Andrew D Rule, Fernando Custodio Fervenza

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Abstract

Objectives: To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS. Patients and Methods: Olmsted County adult residents with native kidney biopsy from January 1, 1994, through December 31, 2013, and FSGS as the only glomerulopathy were identified. The clinical and pathologic characterstics of primary and secondary FSGS were described and compared, and incidence rates were calculated. Results: Of 370 adults biopsied, 281 had glomerular diseases, of which 46 (16%) had FSGS. From 1994-2003 to 2004-2013, there were significant increases in kidney biopsy rates (14.7 [95% CI, 12.1-17.3] vs 22.9 [95% CI, 20.0-25.7] per 100,000 person-years, 17% increase per 5 years; P<.001) and total FSGS rates (1.4 [95% CI, 0.6-2.2] vs 3.2 [95% CI, 2.1-4.3] per 100,000 person-years, 41% increase per 5 years; P=.02). Compared with patients with limited foot process effacement (<80%), patients with diffuse effacement (≥80%) without an identifiable cause had lower serum albumin levels (P<.001), had higher proteinuria (P<.001), and were more likely to have nephrotic syndrome (100% vs 4%; P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3 of 12 patients (25%) during 1994-2003 and 9 of 34 (26%) during 2004-2013. Conclusion: Although the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - 2017

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Focal Segmental Glomerulosclerosis
Incidence
Biopsy
Kidney
Nephrotic Syndrome
Proteinuria
Serum Albumin
Foot

ASJC Scopus subject areas

  • Medicine(all)

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The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis : A Clinicopathologic Study. / Hommos, Musab S.; De Vriese, An S.; Alexander, Mariam P; Sethi, Sanjeev M; Vaughan, Lisa; Zand, Ladan; Bharucha, Kharmen; Lepori, Nicola; Rule, Andrew D; Fervenza, Fernando Custodio.

In: Mayo Clinic Proceedings, 2017.

Research output: Contribution to journalArticle

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title = "The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis: A Clinicopathologic Study",
abstract = "Objectives: To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS. Patients and Methods: Olmsted County adult residents with native kidney biopsy from January 1, 1994, through December 31, 2013, and FSGS as the only glomerulopathy were identified. The clinical and pathologic characterstics of primary and secondary FSGS were described and compared, and incidence rates were calculated. Results: Of 370 adults biopsied, 281 had glomerular diseases, of which 46 (16{\%}) had FSGS. From 1994-2003 to 2004-2013, there were significant increases in kidney biopsy rates (14.7 [95{\%} CI, 12.1-17.3] vs 22.9 [95{\%} CI, 20.0-25.7] per 100,000 person-years, 17{\%} increase per 5 years; P<.001) and total FSGS rates (1.4 [95{\%} CI, 0.6-2.2] vs 3.2 [95{\%} CI, 2.1-4.3] per 100,000 person-years, 41{\%} increase per 5 years; P=.02). Compared with patients with limited foot process effacement (<80{\%}), patients with diffuse effacement (≥80{\%}) without an identifiable cause had lower serum albumin levels (P<.001), had higher proteinuria (P<.001), and were more likely to have nephrotic syndrome (100{\%} vs 4{\%}; P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3 of 12 patients (25{\%}) during 1994-2003 and 9 of 34 (26{\%}) during 2004-2013. Conclusion: Although the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.",
author = "Hommos, {Musab S.} and {De Vriese}, {An S.} and Alexander, {Mariam P} and Sethi, {Sanjeev M} and Lisa Vaughan and Ladan Zand and Kharmen Bharucha and Nicola Lepori and Rule, {Andrew D} and Fervenza, {Fernando Custodio}",
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T1 - The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis

T2 - A Clinicopathologic Study

AU - Hommos, Musab S.

AU - De Vriese, An S.

AU - Alexander, Mariam P

AU - Sethi, Sanjeev M

AU - Vaughan, Lisa

AU - Zand, Ladan

AU - Bharucha, Kharmen

AU - Lepori, Nicola

AU - Rule, Andrew D

AU - Fervenza, Fernando Custodio

PY - 2017

Y1 - 2017

N2 - Objectives: To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS. Patients and Methods: Olmsted County adult residents with native kidney biopsy from January 1, 1994, through December 31, 2013, and FSGS as the only glomerulopathy were identified. The clinical and pathologic characterstics of primary and secondary FSGS were described and compared, and incidence rates were calculated. Results: Of 370 adults biopsied, 281 had glomerular diseases, of which 46 (16%) had FSGS. From 1994-2003 to 2004-2013, there were significant increases in kidney biopsy rates (14.7 [95% CI, 12.1-17.3] vs 22.9 [95% CI, 20.0-25.7] per 100,000 person-years, 17% increase per 5 years; P<.001) and total FSGS rates (1.4 [95% CI, 0.6-2.2] vs 3.2 [95% CI, 2.1-4.3] per 100,000 person-years, 41% increase per 5 years; P=.02). Compared with patients with limited foot process effacement (<80%), patients with diffuse effacement (≥80%) without an identifiable cause had lower serum albumin levels (P<.001), had higher proteinuria (P<.001), and were more likely to have nephrotic syndrome (100% vs 4%; P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3 of 12 patients (25%) during 1994-2003 and 9 of 34 (26%) during 2004-2013. Conclusion: Although the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.

AB - Objectives: To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS. Patients and Methods: Olmsted County adult residents with native kidney biopsy from January 1, 1994, through December 31, 2013, and FSGS as the only glomerulopathy were identified. The clinical and pathologic characterstics of primary and secondary FSGS were described and compared, and incidence rates were calculated. Results: Of 370 adults biopsied, 281 had glomerular diseases, of which 46 (16%) had FSGS. From 1994-2003 to 2004-2013, there were significant increases in kidney biopsy rates (14.7 [95% CI, 12.1-17.3] vs 22.9 [95% CI, 20.0-25.7] per 100,000 person-years, 17% increase per 5 years; P<.001) and total FSGS rates (1.4 [95% CI, 0.6-2.2] vs 3.2 [95% CI, 2.1-4.3] per 100,000 person-years, 41% increase per 5 years; P=.02). Compared with patients with limited foot process effacement (<80%), patients with diffuse effacement (≥80%) without an identifiable cause had lower serum albumin levels (P<.001), had higher proteinuria (P<.001), and were more likely to have nephrotic syndrome (100% vs 4%; P<.001). Patients with diffuse effacement without an identifiable cause were classified as primary FSGS, which accounted for 3 of 12 patients (25%) during 1994-2003 and 9 of 34 (26%) during 2004-2013. Conclusion: Although the incidence of FSGS has increased, the proportions of primary and secondary FSGS have remained stable.

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