#1933 Clinico-pathologic classification of focal segmental glomerulosclerosis to inform on treatment and prognosis
Notice bibliographique
Résumé
Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS) is classified into primary (idiopathic, immune-mediated), secondary (maladaptive, medication-induced or viral-associated), and genetic forms, each differing in disease progression and treatment responses. Despite advancements, misclassification of subtypes remains common due to limited access to genetic testing and lack of definitive biomarkers for primary FSGS. We aimed to determine whether serum albumin, degree of proteinuria, and podocyte foot process effacement (FPE) could be used to improve subtype classification and predict response to immunosuppressive treatments. Method This retrospective, observational cohort study included adult patients with biopsy-proven FSGS at The Ottawa Hospital between 2010 and 2023. Participants were classified into 3 subtypes of FSGS based on clinical and histologic criteria: presumed primary FSGS (serum albumin <35 g/L and proteinuria >3.5 g/day at time of biopsy, and diffuse FPE [>80%] on electron microscopy (EM)), presumed secondary FSGS (serum albumin ≥35 g/L and no diffuse FPE on EM, regardless of the level of proteinuria), and uncategorized FSGS (cases not meeting either criterion). Outcomes included achievement of complete remission (CR) (proteinuria <0.3 g/day), partial remission (PR) (proteinuria <3.5 g/day and > 50% reduction from baseline), progression to end-stage kidney disease (ESKD) (requiring dialysis for ≥12 weeks or initiation of kidney transplant evaluation), death, and change in estimated glomerular filtration rate (eGFR). Logistic regression was performed to examine the association of FSGS category with outcomes, using the presumed secondary FSGS subtype as the reference group, and adjusting for age, sex, and baseline serum creatinine at the time of biopsy. Linear mixed models were performed to examine eGFR throughout follow-up, by FSGS category. Results 187 patients were included with a mean age of 53.8 ± 15.6 years, mean serum creatinine of 167.9 ± 124 μmol/L, and mean urine albumin to creatinine ratio (ACR) of 370.9 ± 431 mg/g at time of kidney biopsy. 54 patients were categorized as having presumed primary FSGS, 72 as presumed secondary, and 61 patients were uncategorized. In the presumed primary FSGS group, 29.6% (aOR = 2.67, reference group Presumed Secondary FSGS; 95% CI: 1.07, 6.63) of patients achieved CR, compared to 15.3% and 9.8% in the presumed secondary and uncategorized FGSG groups, respectively. PR was achieved by 40.7% in the presumed primary FSGS group (aOR = 0.52, reference group Presumed Secondary FSGS; 95% CI: 0.24, 1.10), 58.3% in the presumed secondary and 60.7% in the uncategorized FSGS groups. Those in the presumed primary group more frequently received immunosuppressive treatment in the first 6 months post-biopsy (42.6%, compared to 1.4% in presumed secondary and 16.4% in the uncategorized groups) and had an early improvement in mean eGFR relative to the other groups based on a linear mixed model adjusted for baseline age and eGFR (Fig. 1). Conclusion In patients with biopsy-proven FSGS, disease subtype classification based on serum albumin, level of proteinuria, and degree of FPE at the time of diagnosis may help identify patients with an underlying immune-mediated disease who could respond to immunosuppressive therapy, in terms of achieving remission and potentially improving kidney function. These simple, readily available biomarkers may be useful when deciding on the optimal therapeutic approach for patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».