Caused by an injury to podocytes in the renal glomeruli.
May be primary (idiopathic) due to an unknown cause or secondary to an underlying condition, such as HIV, obesity, medications, and a maladaptive response to decreased renal mass.
May be asymptomatic or present with nephrotic syndrome.
First-line therapy in primary focal segmental glomerulosclerosis with nephrotic-range proteinuria is corticosteroid therapy. Secondary form requires treatment of the underlying cause.
Corticosteroid-dependent and corticosteroid-resistant patients require treatment with other immunosuppressants such as cyclosporine.
Prognosis is extremely variable and depends on the amount of proteinuria, the level of plasma creatinine, the morphologic subtype, the degree of renal fibrosis, and the response to therapy.
Focal segmental glomerulosclerosis (FSGS) is a chronic pathologic process caused by injury to podocytes in the renal glomeruli. It manifests initially with proteinuria, which progresses to nephrotic syndrome and ultimately to end-stage renal failure.
History and exam
- serum HIV enzyme-linked immunosorbent assay
- CD4 count and viral load studies
- parvovirus DNA polymerase chain reaction (PCR)
- cytomegalovirus DNA PCR
- hepatitis B and C serologies
- antinuclear antibody, anti-double-stranded DNA
- serum and urine protein electrophoresis
- renal biopsy
Manish Suneja, MD, FASN, FACP
Department of Internal Medicine
Division of Nephrology
University of Iowa Hospitals and Clinics
MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.
Dr Manish Suneja would like to gratefully acknowledge Dr Divya Movva, a previous contributor to this topic.
DM declares that she has no competing interests.
Catherine Clase, BA, MB, MSC, FRCPC
CC declares that she has no competing interests.
Alain Meyrier, MD
Professor of Medicine
Hopital Europeen Georges Pompidou
AM is an author of a reference cited in this topic.
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