Focal segmental glomerulosclerosis

Last reviewed: 3 Jan 2023
Last updated: 26 Jun 2019

Summary

Definition

History and exam

Key diagnostic factors

  • edema
  • foamy urine
  • hypertension
  • Muehrcke lines
  • xanthelasma and xanthomata
More key diagnostic factors

Other diagnostic factors

  • body mass index 95th percentile or greater
  • lymphadenopathy
  • skin rash
  • oral lesions
  • nephrectomy scar
Other diagnostic factors

Risk factors

  • male sex
  • black race
  • family history of FSGS
  • heroin abuse
  • use of known causative medications
  • chronic viral infection
  • solitary kidney
  • pre-existing renal disease
  • kidney transplant
  • acute renal ischemia
  • obesity
More risk factors

Diagnostic investigations

1st investigations to order

  • serum BUN
  • creatinine
  • GFR
  • urinalysis with microscopy
  • urine protein-to-creatinine ratio
  • 24-hour urine collection for protein
  • serum albumin
  • serum lipid profile
More 1st investigations to order

Investigations to consider

  • 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
More investigations to consider

Treatment algorithm

ACUTE

primary FSGS

secondary FSGS

Contributors

Authors

Manish Suneja, MD, FASN, FACP

Professor

Department of Internal Medicine

Division of Nephrology

University of Iowa Hospitals and Clinics

Iowa City

IA

Disclosures

MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.

Acknowledgements

Dr Manish Suneja would like to gratefully acknowledge Dr Divya Movva, a previous contributor to this topic.

Disclosures

DM declares that she has no competing interests.

Peer reviewers

Catherine Clase, BA, MB, MSC, FRCPC

Associate Professor

Nephrologist

McMaster University

Hamilton

Ontario

Canada

Disclosures

CC declares that she has no competing interests.

Alain Meyrier, MD

Professor of Medicine

Universite Paris-Descartes

Hopital Europeen Georges Pompidou

Paris

France

Disclosures

AM is an author of a reference cited in this topic.

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