Global Data Suggest Increased Prevalence of Focal Segmental Glomerulosclerosis

A recent analysis of global data suggest the reported prevalence of focal segmental glomerulosclerosis (FSGS) has increased over time in most countries.1

With > 32 years of data, the findings provide clinicians with epidemiological information while establishing a foundation for future research to characterize geographic differences, temporal trends, and potential risk factors.1

“This information is crucial for tailoring prevention strategies, refining diagnostic approaches, and guiding future research efforts aimed at addressing the global burden of FSGS,” wrote study investigator Venice Chávez-Valencia, from the Ambulatory Care Medical Unit 254 of the Mexican Social Security Institute, and colleagues.1

Previous research has emphasized slowing disease progression as the primary therapeutic goal in FSGS, but beyond understanding the underlying pathologic mechanisms, improved characterization of geographic and population-level epidemiology may help inform disease recognition and management, particularly given the absence of an FDA-approved pharmacologic therapy for FSGS.2

To address gaps in the literature, Chávez-Valencia and colleagues conducted a systematic review of studies published between 1992 and 2024 using the Medline, Embase, and ScienceDirect databases.1

For inclusion, studies were required to be original research, published in English or Spanish, and to report epidemiological data on FSGS prevalence, incidence, or temporal trends. Exclusion criteria included duplicate publications, insufficient incidence or prevalence data, unavailable full text, incomplete datasets, reporting bias, review articles, transplant registries, conference abstracts, unpublished manuscripts, sample sizes <100 patients, and recurrent FSGS.1

Investigators emphasized substantial heterogeneity across study designs regarding renal biopsy practices, which subsequently limited the comparability of this data.1

After applying the eligibility criteria, investigators included 130 studies in the final analysis. Asia accounted for the largest number of reports (n = 67), followed by Europe (n = 33), the Americas (n = 22), and then Africa (n = 9).1

Across regions, investigators observed substantial variability in reported prevalence, reflecting differences in study design, biopsy practices, and population characteristics rather than true population-level incidence. Together, South Asian and Middle Eastern cohorts had a mean prevalence of 19%, while there was 6.5% in East Asian cohorts.1

In the Americas, several countries reported relatively increased estimates of FSGS rates. In the United States, investigators reported a mean estimate of approximately 20%. Comparisons between time periods, 1994–2003 and 2004–2013, suggested an increase in reported cases over time. In fact, 2 studies reported incidence estimates of approximately 1.6 cases per 100,000 individuals per year.1

Investigators noted relatively similar prevalence rates between European countries, with an average of 10%. They also pointed out that several studies, particularly from Africa and parts of Asia, had an increased proportion of FSGS among pediatric patients, underscoring age-related differences in disease burden and diagnosis.1

“It is important to note that data from many countries are based on limited samples, not numerically representative of the population, which means that actual prevalence rates of FSGS may differ from those reported,” concluded investigators. “Despite these limitations, this study provides valuable information on an estimate of the overall prevalence of FSGS in different countries and, in some cases, highlights trends and changes over time.”1

References:

1. Orizaga-de-la-Cruz C, Lagunas-Rangel FA, Gómez-García A, Chávez-Valencia V, et al. An approximation to the prevalence of focal segmental glomerulosclerosis: A systematic review of world literature over the past 32 years. Nefrología (English Edition). 2025;45(10):501404. doi:https://doi.org/10.1016/j.nefroe.2025.501404

2. Abbate M, Zoja C, Remuzzi G. How Does Proteinuria Cause Progressive Renal Damage? Journal of the American Society of Nephrology. 2006;17(11):2974-2984. doi:https://doi.org/10.1681/ASN.2006040377