Effects of steroids in focal segmental glomerulosclerosis in a predominantly African-American population

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a common primary glomerulopathy in African Americans. Prolonged treatment with steroids is recommended for FSGS in those with nephrotic-range proteinuria, but strong evidence for this recommendation, especially in African-American adults, is lacking. We reviewed our experience with steroids in FSGS in a predominantly African-American cohort. METHODS: Patients with primary FSGS were identified and their charts were retrospectively reviewed for demographic data, characteristics of renal biopsy, blood pressure, and use of steroids. End-stage renal disease and doubling of creatinine were end-points. RESULTS: Seventy-two patients (65 African Americans) were identified with 48.3 months of follow-up. Patients receiving steroids (n=43) had higher urine protein excretion than those who did not. Seventeen patients reached end-stage renal disease and 26 doubled their creatinine concentration. Factors significant for renal survival on Cox proportional hazards model were initial creatinine level, severity of renal lesion, and blood pressure over the follow-up period. Treatment with steroids did not affect renal survival. About one third of patients receiving steroids developed complications consisting of diabetes (n=4) and greater than 5 kg weight gain (n=10). CONCLUSION: Renal function, severity of the renal lesion, and blood pressure determine renal survival in FSGS. A beneficial effect of steroids was not observed in this predominantly African-American adult cohort.