genitourinary disorders
Focal Segmental Glomerulosclerosis
Treatment of Focal Segmental Glomerulosclerosis
Angiotensin inhibition Corticosteroids and sometimes other immunosuppressive agents for idiopathic FSGS Kidney transplantation for patients with end-stage kidney disease receptor blocker [ARB]) unless contraindicated by Angioedema or In idiopathic FSGS, a trial of immunosuppressive therapy is indicated if proteinuria reaches the nephrotic range or if renal function worsens, especially if Renal biopsy reveals a tip lesion. In contrast, patients with secondary FSGS, collapsing FSGS, or advanced tubulointerstitial fibrosis on renal biopsy are generally not treated with immunosuppression because they tend to not respond; instead, the primary disorder is treated. High-dose corticosteroids (eg,prednisone1 mg/kg orally once a day or 2 mg/kg every other day) are recommended for at least 2 months, although some experts recommend use for up to 9 months. Response rates of 30 to 50% have been reported with prolonged therapy and vary by the histologic classification of FSGS. After a 2-week remission of proteinuria, the corticosteroid is slowly tapered over≥2 months. Secondary and familial cases, collapsing FSGS, and advanced tubulointerstitial fibrosis are more likely to be corticosteroid-resistant. If only slight improvement or relapse occurs with corticosteroid therapy, remission may be induced with a calcineurin inhibitor (eg,cyclosporineortacrolimus) for at least 6 months. Although calcineurin inhibitors have been studied more thantacrolimusfor FSGS, some clinicians prefertacrolimusbecause it is commonly used for other glomerular diseases and there is a lower risk of cosmetic side effects (eg, hirsutism, gingival hyperplasia). In selected cases,mycophenolatemofetil may be used as an alternative. In patients with contraindications to high-dose corticosteroids (eg, diabetes, osteoporosis), a calcineurin inhibitor can be given along with a lower dose of corticosteroids (eg,prednisone0.15 mg/kg orally once a day). An alternative is Plasma exchange in combination with immunosuppression. 