Develop and Validate a Risk Score in Predicting Renal Failure in Focal Segmental Glomerulosclerosis

Introduction The aim of this study is to develop and validate a risk score for end stage kidney disease (ESKD) in patients with focal segmental glomerulosclerosis (FSGS).Methods Patient with biopsy proven FSGS were enrolled. All the patients were allocated 1:1 to the two groups according to their baseline gender, age and baseline creatinine level by using a stratified randomization method. ESKD was the primary endpoint. Results We recruited 359 FSGS patients,177 subjects were assigned to group 1 and 182 to group 2. The clinicopathological variables were similar between two groups. There were 23 (13%) subjects reached to ESKD in group 1 and 22 (12.1%) in group 2. By multivariate Cox regression analyses we established risk scores (RS) 1 and RS 2 in groups 1 and 2, respectively. RS1 consists of five parameters including lower eGFR, higher urine protein, MAP, IgG level, and tubular-interstitial lesion (TIL) score; RS2 also consists of five predictors including lower C3, higher MAP, IgG level, hemoglobin and TIL score. RS1 and RS2 were cross-validated between these two groups, showing RS1 had better performance in predicting 5-year ESKD in Group1 [c statics, 0.86(0.74-0.98) vs 0.82(0.69-0.95] and Group2 [c statics, 0.91(0.83-0.99) vs 0.89(0.79-0.99)] compared to RS2. We then stratified the risk factors into four groups and Kaplan-Meier survival curve revealed that patients progressed to ESKD increased as risk levels increased. Conclusions A predictive model incorporated clinicopathological features was developed and validated for the prediction of ESKD in FSGS patients.