Clinical course of focal segmental glomerulosclerosis associated with hepatosplenic schistosomiasis mansoni.

To analyze the clinical course and response to therapy 15 patients (9 male and 6 female) with the hepatosplenic form of schistosomiasis mansoni and focal segmental glomerulosclerosis (FSGS) were prospectively studied (mean follow-up = 115.8 +/- 93.2 months). Nephrotic syndrome was the most frequent clinical presentation, followed by abnormalities of urinalysis. The clinical course was progressive: at final evaluation 9 patients (60%) had developed renal failure. Hypertension or/and renal insufficiency at initial evaluation and persistence of the nephrotic syndrome were associated with progression toward advanced renal failure. Response to immunosuppressive therapy was recorded in 30% of the patients; all responsive patients still had normal renal function at final evaluation. The treatment of the Schistosoma mansoni infection did not influence the clinical course of the renal disease. It is concluded that FSGS in patients with hepatosplenic schistosomiasis mansoni is a disease progressing to advanced stage independently of the presence of the parasite.