Urinary IgG and α 2-macroglobulin are powerful predictors of outcome and responsiveness to steroids and cyclophosphamide in idiopathic focal segmental glomerulosclerosis with nephrotic syndrome

Objective. To assess whether high-molecular-weight proteins excretion predicts outcome and therapy-responsiveness in patients with FSGS and nephrotic syndrome. Research Design and Methods. Thirty-eight patients measured at biopsy fractional excretion of IgG (FEIgG) and urinary \u3b12-macroglobulin/ creatinine ratio (\u3b12m/C). Low and high risk groups were defined by cutoffs assessed by ROC analysis. In all patients first-line therapy was with steroids alone or in combination with cyclophosphamide. Results. \u3b12m/C and FEIgG were correlated with segmental sclerosis (r=0.546; r=0.522). Twenty-three patients (61%) entered Remission and 9 (24%) progressed to ESRD. Comparing low and high risk groups, by univariate analysis remission was predicted by FEIgG (77% versus 25%, P=0.016) and \u3b12m/C (81% versus 17%, P=0.007) and ESRD at best by FEIgG (0% versus 75%, P<0.0001) and \u3b12m/C (4% versus 67%, P<0.0001). By multivariate analysis FEIgG was the only independent predictor of remission and \u3b12m/C the most powerful predictor of ESRD. Low and high risk groups of FEIgG and \u3b12m/C in combination had very high predictive value of sustained remission and ESRD in response to therapy. Conclusions. FEIgG and \u3b12m/C are powerful predictors of outcome and responsiveness to steroids and cyclophosphamide; their predictive value, if validated in prospective studies, may be useful in clinical practice suggesting first-line alternative treatments in high risk patients

Continuous increase in HIV-1 incidence after the year 2000 among men who have sex with men in Rome: insights from a 25-year retrospective cohort study

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