{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:23Z","timestamp":1786480283773,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>FSGS is a heterogeneic glomerular disease. Risk factors for kidney disease ESKD and the effect of immunosuppression treatment (IST) has varied in previously published cohorts. These cohorts were limited by relatively small case numbers, short follow-up, lack of racial\/ethnic diversity, a mix of adult and pediatric patients, lack of renin-angiotensin-aldosterone system (RAAS) inhibition, or lack of subgroup analysis of IST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We compared demographics, clinical characteristics, histopathology, and IST to long-term renal survival in a large, ethnically diverse, adult cohort of 338 patients with biopsy-proven FSGS with long-term follow-up in the era of RAAS inhibition using data from the US Department of Defense health care network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Multivariate analysis showed that nephrotic-range proteinuria (NRP), eGFR &lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , hypoalbuminemia, interstitial fibrosis and tubular atrophy, and interstitial inflammation at diagnosis and the absence of remission were all associated with worse long-term renal survival. IgM, C3, and a combination of IgM\/C3 immunofluorescence staining were not associated with reduced renal survival. IST was not associated with improved renal survival in the whole cohort, or in a subgroup with NRP. However, IST was associated with better renal survival in a subgroup of patients with FSGS with both NRP and hypoalbuminemia and hypoalbuminemia alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study suggests that IST should be reserved for patients with FSGS and nephrotic syndrome. It also introduces interstitial inflammation as a potential risk factor for ESKD and does not support the proposed pathogenicity of IgM and complement activation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0006172020","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T18:45:15Z","timestamp":1606848315000},"page":"105-113","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Focal Segmental Glomerulosclerosis, Risk Factors for End Stage Kidney Disease, and Response to Immunosuppression"],"prefix":"10.34067","volume":"2","author":[{"given":"Benjamin M.","family":"Forster","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Nee","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin J.","family":"Little","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center, Nephrology Department and Late Development, Cardiovascular, Renal and Metabolism BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Greasley","sequence":"additional","affiliation":[{"name":"Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James B.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Tripler Army Medical Center, Nephrology Department, Honolulu, Hawaii"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Olson","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center, Nephrology Department, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"B1-20250825","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1681\/ASN.2012040389","article-title":"Treatment of primary FSGS in adults","volume":"23","author":"Korbet","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"B2-20250825","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1681\/ASN.2017090958","article-title":"Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach","volume":"29","author":"De Vriese","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"B3-20250825","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0272-6386(12)80128-4","article-title":"Primary focal segmental glomerulosclerosis: clinical course and response to therapy","volume":"23","author":"Korbet","year":"1994","journal-title":"Am J Kidney Dis"},{"key":"B4-20250825","doi-asserted-by":"crossref","first-page":"386","DOI":"10.2215\/CJN.07110615","article-title":"Treatment with glucocorticoids or calcineurin inhibitors in primary FSGS","volume":"11","author":"Laurin","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B5-20250825","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1681\/ASN.2004070593","article-title":"Focal and segmental glomerulosclerosis: Definition and relevance of a partial remission","volume":"16","author":"Troyanov","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B6-20250825","first-page":"115","article-title":"Long-term prognosis of focal sclerosing glomerulonephritis. An analysis of 250 cases with particular regard to tubulointerstitial changes","volume":"33","author":"Wehrmann","year":"1990","journal-title":"Clin Nephrol"},{"key":"B7-20250825","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/qjmed\/hci072","article-title":"Treatment and outcome of adult patients with primary focal segmental glomerulosclerosis in five UK renal units","volume":"98","author":"Stirling","year":"2005","journal-title":"QJM"},{"key":"B8-20250825","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1681\/ASN.2011040388","article-title":"APOL1 genetic variants in focal segmental glomerulosclerosis and HIV-associated nephropathy","volume":"22","author":"Kopp","year":"2011","journal-title":"J Am Soc Nephrol"},{"key":"B9-20250825","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1097\/01.ASN.0000135051.62500.97","article-title":"Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants","volume":"15","author":"Chun","year":"2004","journal-title":"J Am Soc Nephrol"},{"key":"B10-20250825","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/0272-6386(95)90120-5","article-title":"Focal segmental glomerular sclerosis in adults: presentation, course, and response to treatment","volume":"25","author":"Rydel","year":"1995","journal-title":"Am J Kidney Dis"},{"key":"B11-20250825","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1053\/ajkd.1998.v32.pm9669427","article-title":"Long-term outcome in children and adults with classic focal segmental glomerulosclerosis","volume":"32","author":"Cattran","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"B12-20250825","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/00005792-198609000-00003","article-title":"The prognosis of focal segmental glomerular sclerosis of adulthood","volume":"65","author":"Korbet","year":"1986","journal-title":"Medicine (Baltimore)"},{"key":"B13-20250825","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1681\/ASN.V1091900","article-title":"Focal segmental glomerulosclerosis: prognostic implications of the cellular lesion","volume":"10","author":"Schwartz","year":"1999","journal-title":"J Am Soc Nephrol"},{"key":"B14-20250825","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.2215\/CJN.13091215","article-title":"Renal survival in patients with collapsing compared with not otherwise specified FSGS","volume":"11","author":"Laurin","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B15-20250825","first-page":"213","article-title":"The long-term prognosis of patients with focal segmental glomerulosclerosis","volume":"10","author":"Cameron","year":"1978","journal-title":"Clin Nephrol"},{"key":"B16-20250825","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3899\/jrheum.171186","article-title":"Risk factors for future scleroderma renal crisis at systemic sclerosis diagnosis","volume":"46","author":"Gordon","year":"2019","journal-title":"J Rheumatol"},{"key":"B17-20250825","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1053\/snep.2003.50020","article-title":"Angiotensin antagonists and steroids in the treatment of focal segmental glomerulosclerosis","volume":"23","author":"Korbet","year":"2003","journal-title":"Semin Nephrol"},{"key":"B18-20250825","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/S0002-9629(15)40759-1","article-title":"Focal segmental glomerulosclerosis in African Americans: effects of steroids and angiotensin converting enzyme inhibitors","volume":"319","author":"Crenshaw","year":"2000","journal-title":"Am J Med Sci"},{"key":"B19-20250825","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0272-6386(12)80696-2","article-title":"Long-term beneficial effects of angiotensin-converting enzyme inhibition in patients with nephrotic proteinuria","volume":"20","author":"Praga","year":"1992","journal-title":"Am J Kidney Dis"},{"key":"B20-20250825","first-page":"89","article-title":"Effects of angiotensin-converting enzyme inhibitor and steroid therapy on proteinuria in FSGS: a retrospective study in a single clinic","volume":"56","author":"Stiles","year":"2001","journal-title":"Clin Nephrol"},{"key":"B21-20250825","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1681\/ASN.2012020187","article-title":"IgM contributes to glomerular injury in FSGS","volume":"24","author":"Strassheim","year":"2013","journal-title":"J Am Soc Nephrol"},{"key":"B22-20250825","doi-asserted-by":"crossref","first-page":"e0136558","DOI":"10.1371\/journal.pone.0136558","article-title":"Complement activation in patients with focal segmental glomerulosclerosis","volume":"10","author":"Thurman","year":"2015","journal-title":"PLoS One"},{"key":"B23-20250825","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.2215\/CJN.01190216","article-title":"Clinical significance of IgM and C3 glomerular deposition in primary focal segmental glomerulosclerosis","volume":"11","author":"Zhang","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B24-20250825","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1159\/000501827","article-title":"Co-eposition of IgM and C3 may indicate unfavorable renal outcomes in adult patients with primary focal segmental glomerulosclerosis","volume":"44","author":"Mirioglu","year":"2019","journal-title":"Kidney Blood Press Res"},{"key":"B25-20250825","doi-asserted-by":"crossref","first-page":"e0234934","DOI":"10.1371\/journal.pone.0234934","article-title":"Complement activation profile of patients with primary focal segmental glomerulosclerosis","volume":"15","author":"Huang","year":"2020","journal-title":"PLoS One"},{"key":"B28-20250825","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1126\/science.1193032","article-title":"Association of trypanolytic ApoL1 variants with kidney disease in African Americans","volume":"329","author":"Genovese","year":"2010","journal-title":"Science"},{"issue":"Suppl 1","key":"B29-20250825","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1053\/j.ajkd.2018.06.020","article-title":"APOL1-associated nephropathy: A key contributor to racial disparities in CKD","volume":"72","author":"Freedman","year":"2018","journal-title":"Am J Kidney Dis"}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0006172020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:01:41Z","timestamp":1786478501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0006172020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0006172020","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"assertion":[{"value":"2020-10-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}