Logo image
Back
Clinical Decision-Making About Immunosuppressive Treatment in Focal Segmental Glomerulosclerosis
Journal article   Open access   Peer reviewed

Clinical Decision-Making About Immunosuppressive Treatment in Focal Segmental Glomerulosclerosis

Brooke Blazius, Jonathan P. Troost, Jeffrey B. Kopp, Rulan S. Parekh, Brenda Gillespie, Isabelle Ayoub, Mahmoud Kallash, Rasheed Gbadegesin, Pietro A. Canetta, Tarak Srivastava, …
Kidney medicine, Vol.7(4), 100975
04/2025
DOI: 10.1016/j.xkme.2025.100975
PMCID: PMC11982957
PMID: 40212319
url
https://doi.org/10.1016/j.xkme.2025.100975View
Published (Version of record) Open Access

Abstract

Rationale & Objective Focal segmental glomerulosclerosis (FSGS) is a heterogeneous disorder with a high risk of progression to kidney failure. There are no approved therapies for FSGS, and futility of treatment is poorly defined. The Cure Glomerulonephropathy (CureGN) study offers the opportunity to describe the characteristics of participants who started immunosuppressive therapy (IST), never received IST or in whom this treatment was discontinued. Study Design Observational cohort Settings & Participants Participants enrolled in CureGN with FSGS and surveyed nephrologists. Interventions The clinical and laboratory data from participants with FSGS who were enrolled in the CureGN observational cohort were reviewed to define features associated with withholding initial IST or terminating ongoing IST. Nephrologists were surveyed about what factors would influence their decision to prescribe or withdraw IST in patients with FSGS. Outcomes (1) Identify factors associated with IST initiation and discontinuation in individuals with FSGS.(2) Identify clinical and laboratory features nephrologists consider when they recommend against the use of IST at diagnosis (initiation of care) and during the course of disease. Results Based on quantitative findings from the CureGN cohort and survey responses from practicing nephrologists, a low estimated glomerular filtration rate (eGFR) at presentation, significant glomerulosclerosis, and interstitial fibrosis and tubular atrophy (IFTA) on kidney biopsy make initiation of IST less likely. Limitations Heterogeneous nature of the cohort and an inability to divide the patients into KDIGO subgroups of FSGS. Rationale for decision to stop or defer treatment was not available. More surveys were completed by pediatric providers and the majority were completed by academic practitioners. Conclusions The factors that impact decisions about IST initiation and discontinuation were consistent among pediatric and internal medicine nephrologists, namely advanced scarring and lower eGFR. We suggest that this information should be incorporated into patient management guidelines and clinical trial design.

Details

Metrics

5 Record Views
Logo image