genitourinary disorders
Focal Segmental Glomerulosclerosis
Introduction
Focal segmental glomerulosclerosis is scattered (segmental) mesangial sclerosis that begins in some but not all (focal) glomeruli and eventually involves all glomeruli. It is most often idiopathic but may be secondary to use of heroin or other drugs, HIV infection, obesity, sickle cell disease, atheroembolic disease, or nephron loss (eg, in reflux nephropathy, subtotal nephrectomy, or renal dysgenesis). It manifests mainly in adolescents but also in young and middle-aged adults. Patients have insidious onset of proteinuria, mild hematuria, hypertension, and azotemia. Diagnosis is confirmed by renal biopsy. Treatment is with angiotensin inhibition and, for idiopathic disease, corticosteroids and sometimes other immunosuppressive agents. Focal segmental glomerulosclerosis (FSGS) is now the most common cause of idiopathic (or primary) Overview of Nephrotic Syndrome among adults in the United States. It is especially common in Black men. Though usually idiopathic, FSGS can occur in association with other factors (secondary FSGS), including medications and illicit drugs (eg, heroin, In FSGS, the glomerular filtration barriers for size and molecular charge are defective, and proteinuria is typically nonselective, affecting high molecular-weight proteins (eg, immunoglobulins) as well asalbumin. Kidneys tend to be small. 