Clinicopathological Characteristics of Adult Patients in the United States with Focal Segmental Glomerulosclerosis (FSGS)

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American Society of Neohrology


washington; spokane; pshmc



Focal segmental glomerulosclerosis (FSGS) is a common histopathologic lesion of glomerular injury in patients with nephrotic syndrome. These analyses characterize clinical and histological features of FSGS in adults at time of kidney biopsy.


A retrospective study was performed using data from the Arkana Biopsy Database (January 1, 2016 to May 31, 2020) in patients that met study criteria, which included: ≥18 yrs, ≥1 FSGS positive kidney biopsy, and no prior kidney transplant, and available data on race/ethnicity. Outcomes included clinical and histologic characteristics. eGFR was calculated using CKD-EPI-creatinine equation without race modifier.


Of 64,105 adult kidney biopsies performed during the study period, 2,065 (3.2%) FSGS positive cases were identified and 1,482 pts (71.8%) evaluated met study criteria. Demographic characteristics included: 56.2% male, 55.1% White, 32.1% African American (AA), 7.7% Hispanic and 3.4% Asian. Overall mean (SD) age at biopsy was 49.0 (17.2) with older ages in Whites (52.8 (17.3) yrs) and younger ages in Hispanics (39.4 (15.8) yrs). Mean urine protein to creatinine ratio was similar by race/ethnicity (range 5.1-6.0 g/g). Asians were more frequently biopsied at eGFR Stage 4 (32.7%) compared to other race/ethnicity groups: AAs (29.0%), Whites (23.1%), and Hispanics (18.7%). The highest rates of ≥50% global glomerular sclerosis (GS) were observed in AAs (31.1%) and lowest in Whites (14.6%). Whites (51.9%) and AAs (39.7%) exhibited the highest rates of severe foot process effacement (≥80%), while interstitial fibrosis and tubular atrophy >50% was more common in AAs (34.6%) compared to Hispanics (27.2%), Asians (17.7%) or Whites (14.7%). Of all FSGS types, “not otherwise specified” was most common across all race/ethnicity groups (range 64.2-75.4%). Among other FSGS types, tip lesion was most frequent in Whites (21.5%) and collapsing was most frequent in AA patients (12.4%).


Non-White patients are more frequently diagnosed with FSGS at later CKD stages with advanced GS. Strategies to improve earlier awareness and detection of FSGS are needed to allow effective intervention before severe kidney damage has occurred.

Clinical Institute

Kidney & Diabetes