Treatment Principles of Focal Segmental Glomerulosclerosis (FSGS)

Treatment Principles of Focal Segmental Glomerulosclerosis (FSGS)
The incidence of FSGS has been increasing in recent years. Today let’s have a look at its treatment principles. Hope it can help you.

First of all, FSGS manifests as massive proteinuria, hematuria, high blood pressure, kidney function impairment, steroid-resistant, and persistent progression, etc. Among them, proteinuria and creatinine level are closely associated with prognosis. Studies have shown that about 50% of FSGS patients who presents Nephrotic Syndrome go into kidney failure after 5-10 years. For patients with obvious proteinuria, it may only take 5 years or less to go into ESRD. Therefore, during treatment, proteinuria and kidney function change should be attached importance.

1. Initial treatment

Primary FSGS is often treated by steroids. 80% of studies show that over 30% of patients get complete remission. And the time for remission may be 3-4 months.

2. Treatment for relapse

Clinical statistics showed that the longer the remission time, the lower the relapse rate. Patients whose remission time is over 10 years have a good prognosis. And their disease seldom gets relapse. The treatment of recurrence usually depends on its frequency. For patients who have stopped steroid intake for over 6 months, they can use the conventional steroid treatment again. For those with frequent relapse (over 2 times in 6 months), steroid-dependence, and steroid-resistance, cytotoxic or cyclosporine should be used.

3. Treatment for steroid-resistant

The use of cyclosporine for steroid-resistance in children and adults has a higher rate of remission. And it can protect renal function. Besides, the effect in children is better than adult. The combination of low doses of prednisolone and cyclosporine can help FSGS patients with steroid-resistance to get into remission and reduce the relapse when cyclosporine is tapered or stopped.

4. Other treatment

Besides steroids and cytotoxic, treatment for FSGS should also include finding out and eliminating the potential focus, controlling blood pressure aggressively, anti-coagulation, adjusting cholesterol level, anti-oxidative stress, etc. Given the circulating factors may be the important pathogenic factor of FSGS. Before and after kidney transplant, plasma exchange and immune absorption can be applied to improve the survival rate.

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