Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study
| Autor: | Amin R. Soliman, Hoda Abdel Hamid Maamoun, Rabab Mahmoud Ahmed, Haytham Soliman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Drug Resistance 030232 urology & nephrology Blood Pressure 030204 cardiovascular system & hematology urologic and male genital diseases Single Center 0302 clinical medicine Focal segmental glomerulosclerosis Fibrosis Prospective Studies Internal medicine Proteinuria medicine.diagnostic_test Glomerulosclerosis Focal Segmental steroid Eye Diseases Hereditary Arterioles Treatment Outcome Cyclosporine Prednisolone Drug Therapy Combination Female Renal biopsy medicine.symptom Immunosuppressive Agents Glomerular Filtration Rate medicine.drug Adult Diarrhea Hyalin medicine.medical_specialty Urology Renal function 03 medical and health sciences medicine Humans Vascular Diseases Glucocorticoids focal segmental glomerulosclerosis business.industry Mycophenolic Acid medicine.disease RC31-1245 Intestinal Diseases Blood pressure Skin Abnormalities business |
| Zdroj: | Romanian Journal of Internal Medicine, Vol 59, Iss 2, Pp 127-133 (2021) |
| ISSN: | 2501-062X |
| Popis: | Background. Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic parameters in patients with steroid resistant focal segmental glomerulosclerosis (FSGS). The purpose of the present study is to compare the effect of cyclosporin and mycophenolate mofetil in addition to steroids on functional and histopathologic renal parameters in patients with steroid resistant FSGS one year after treatment. Material and methods. Thirty-seven adults with primary FSGS patients resistant to steroid therapy consecutively randomized to treatment with either MMF or cyclosporine. Low dose prednisolone added to both groups. Glomerular filtration rate (GFR) and blood pressure (BP) were determined at all examinations and a second renal biopsy was taken 12 months after treatment with either of cyclosporin and mycophenolate mofetil. Results. GFR significantly increased in MMF group p < 0.01 after 6 months and unchanged after 12 months. On the other hand, GFR significantly decrease in CsA group p < 0.001 after 6 months and reduced more after 12 months p < 0.001 compared to base line levels. There was a significant difference of GFR between the 2 groups at 6 months p < 0.001. The extent of proteinuria decreased significantly in CsA group after 12 months p < 0.001. The extent of arteriolar hyalinosis increased significantly in CsA group (0.78 to 1.81 score, p < 0.001) but was unchanged in MMF group (0.93 to 0.96 score), whereas interstitial fibrosis increased to same level in both groups (grade 3). Conclusion. Conversion to MMF in those patients may be superior to CsA as regards GFR after 12 months after treatment in spite of the presence of greater level of protein excretion. The increased arteriolar hyalinosis during CsA treatment most likely results in higher BP compared to MMF treatment in patients with FSGS resistant to steroids. |
| Databáze: | OpenAIRE |
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