Treatment and Outcome of Idiopathic Focal Segmental Glomerulosclerosis: Immunosuppressive Agents or Renin Angiotensin System Inhibitors

OBJECTIVE: We compared the efficacy and safety of 12 months of three different treatment regimens. MATERIAL and METHODS: We retrospectively investigated the pathological and clinical features of 70 patients with FSGS confirmed by biopsy. Patients with secondary FSGS, estimated glomerular filtration rate <30 mL/min/1.73 m2 and history of diabetes mellitus were excluded. Eligible 51 patients were randomly assigned to receive treatment with renin-angiotensin system (RAS) inhibitors (group 1, n= 13), steroid (group 2, n= 22) or steroid + Cyclosporine (CsA) (group 3, n= 16). RESULTS: At the end of the one year, remission ocurred in 7 patients (53.8%) (4 complete and 3 partial) in group 1, 15 patients (68%) (12 complete and 3 partial) in group 2 and 8 patients (50%) (6 complete and 2 partial) in group 3 (p= 0.483). The baseline proteinuria levels of patients in group 2 (5.41 +/- 3.91 g/day) and group 3 (5.96 +/- 4.83 g/day) were significantly decreased to 2.03 +/- 3.16 g/day (p= 0.004) and 2.03 +/- 2.40 g/day (p= 0.012), respectively. However, the baseline proteinuria levels of patients in group 1 were not significantly decreased at one year of treatment. CONCLUSION: Steroid treatment or CsA in combination with low-dose steroids show similar efficacy in inducing remission in patients with idiopathic FSGS.