Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- edema
- orina espumosa
- hipertensión
- líneas de Muehrcke
- xantelasmas y xantomas
Other diagnostic factors
- índice de masa corporal igual o superior al percentil 95
- linfadenopatía
- erupción cutánea
- lesiones orales
- cicatriz de nefrectomía
Risk factors
- sexo masculino
- raza negra
- antecedentes familiares de la GEFS
- abuso de heroína
- uso de medicamentos causales conocidos
- infección viral crónica
- riñón único
- enfermedad renal preexistente
- trasplante de riñón
- isquemia renal aguda
- obesidad
Diagnostic investigations
1st investigations to order
- urea sérica
- creatinina
- tasa de filtración glomerular (TFG)
- análisis de orina con microscopía
- relación proteína/creatinina en orina
- recolección de orina de 24 horas para proteína
- albúmina sérica
- lipidograma sérico
Investigations to consider
- ensayo de inmunoabsorción enzimática del VIH en suero
- recuento de CD4 y estudios de carga viral
- ADN del parvovirus por reacción en cadena de la polimerasa (PCR)
- ADN del citomegalovirus por reacción en cadena de la polimerasa (PCR)
- serologías de hepatitis B y C
- anticuerpo antinuclear, ADN bicatenario
- electroforesis de proteínas en suero y orina
- biopsia renal
Treatment algorithm
glomeruloesclerosis focal y segmentaria (GEFS) primaria
glomeruloesclerosis focal y segmentaria (GEFS) secundaria
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Rosenberg AZ, Kopp JB. Focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2017 Mar 7;12(3):502-17.Full text Abstract
Beaudreuil S, Lorenzo HK, Elias M, et al. Optimal management of primary focal segmental glomerulosclerosis in adults. Int J Nephrol Renovasc Dis. 2017 May 10;10:97-107.Full text Abstract
Kidney Disease: Improving Global Outcomes. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Oct 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Nefropatía membranosa
- Enfermedad con cambios mínimos
- Amiloidosis
More DifferentialsGuidelines
- KDIGO 2021 Clinical practice guideline for the management of glomerular diseases
- Evidence-based clinical practice guidelines for nephrotic syndrome
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Obesidad: fármacos y cirugía
Problemas de peso en niños
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Estimación de tasa de filtración glomerular por la ecuación del estudio IDMS-Traceable MDRD
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