Anemia in FSGS patients: Incidental Comorbidity or a Neglected Contributor?

Abstract

Introduction: Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerulonephrites. Several mechanisms have been proposed that may lead to treatment non-response in primary FSGS, such as the baseline proteinuria amount, histopathological sclerosis rate, and undiagnosed patients with secondary FSGS. This study investigated the possible factors affecting treatment response in primary FSGS. Methods: Our study is a single-center retrospective cohort study that included patients diagnosed with focal segmental glomerulosclerosis by renal biopsies between 2008 and 2018. A total of 185 patients diagnosed with FSGS were identified. The FSGS subtypes of these patients were recorded. There were 57 patients with complete follow-up and treatment histories. Forty-one of these patients were primary FSGS, and 16 were secondary FSGS. Baseline characteristics, laboratory parameters, histopathologic findings, and initial treatments were analyzed in patients with primary FSGS. Responders and non-responders to initial treatments were compared, and risk factors for nonresponsiveness were analyzed in the sixth month of the initial treatment. Results: No difference existed in the responder and non-responder patients' basal characteristics, most laboratory parameters, or histopathologic features. Responders had significantly higher baseline hemoglobin levels than non-responders [13.5 (±1.5) and 12.1 (±2.9), respectively; p=0.003]. Anemia significantly increased the risk of treatment nonresponsiveness [OR: 8.12 (min: 1.12 – max: 66.16), p=0.048]. Conclusions: The results of our study suggest that the presence of anemia may be a risk factor for FSGS initial treatment nonresponsiveness. Although the relationship between anemia and organ fibrosis is known, uncertainty exists about whether anemia is pathophysiologically related to FSGS or incidental due to its high prevalence. More studies are needed to clarify this uncertainty.