Can Biomarkers of Disease Activity Guide Treatment in FSGS?

[摘要] FSGS is a heterogeneous disorder that is an important cause of nephrotic syndrome (1). It is not a disease but rather a histologic pattern of injury characterized on kidney biopsy by segmental areas of mesangial sclerosis in some but not all glomeruli (2). Podocyte foot process effacement is invariably detected on electron microscopy, and no specific immune deposits are usually seen with immunofluorescence microscopy (3). Secondary causes of FSGS include obesity, hypertension, and viral nephritides (2). Therapy is directed to individuals with primary FSGS, particularly those with nephrotic-range proteinuria, who are deemed high risk for progression to ESRD. In addition to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, these patients are typically treated with high-dose steroids for at least 8–12 weeks (4). If they do not achieve a clinical remission, agents such as calcineurin inhibitors or other immune modulators are administered (5). Patients who do not respond to steroids have a poor prognosis, being much more likely to experience a progressive decline in renal function (6).

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome