Glucocorticoids in the treatment of patients with primary focal segmental glomerulosclerosis and moderate proteinuria

• Published in: Clinical and experimental nephrology Vol. 22; no. 6; pp. 1315 - 1323
• Main Authors: Huang, Jianni, Lin, Li, Xie, Jingyuan, Li, Xiao, Shen, Pingyan, Pan, Xiaoxia, Ren, Hong, Chen, Nan
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.12.2018; Springer Nature B.V
• Subjects: Angiotensin; Angiotensin-converting enzyme inhibitors; Creatinine; Epidermal growth factor receptors; Glucocorticoids; Medicine; Medicine & Public Health; Nephrology; Original Article; Patients; Peptidyl-dipeptidase A; Proteins; Proteinuria; Remission; Urine; Urology; Steroid; ACEI; FSGS; ARB; Treatment
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-018-1585-z

Background To compare the efficacy of glucocorticoids in primary focal segmental glomerulosclerosis (pFSGS) patients with moderate proteinuria. Registered at http://www.chictr.org.cn/ , study No. ChiCTR-OPN-17012789. Methods pFSGS patients with urine protein between 1.0 and 3.5 g/24 h were recruited from 2006 to 2016. No decline in urine protein > 50% was observed after 2 months of run-in angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB) treatment. Patients were assigned to study group (glucocorticoids with ACEI/ARB) or control group (ACEI/ARB without glucocorticoids). Variables including 24-h urinary protein, serum albumin and serum creatinine during the trial were recorded. Remission was defined as proteinuria < 0.3 g/24 h or declined > 50%, and our composite end point as > 30% decrease of eGFR or eGFR < 30 ml/min. Results A total of 102 patients were enrolled (study group N  = 52, control group N  = 50), and the median follow-up time was 36 (12–117) months without significant difference between groups. During the 12-month follow-up, the remission rate was significantly higher in study group [73.1 vs 50.0% ( P  = 0.01)], and the initial median response time was 3 months in the study group while 6 in the control group. The end point was reached by 22.2% cases in study group, and 42.0% in control. The medium survival times were study group 72 months and control 57 ( P  = 0.03). Minor adverse reactions were observed in 10 patients (study group N  = 8, control group N  = 2). Conclusions Additional glucocorticoids therapy is more efficacious compared to ACEI/ARB alone in the treatment of patients with pFSGS and moderate proteinuria.