Focal segmental glomerulosclerosis (FSGS)

the most common cause of nephrotic syndrome in adults, especially in African Americans

may be idiopathic or

Associations:

• secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
• HIV
• heroin
• Alport's syndrome
• sickle-cell
• morbid obesity

Presentation: maybe quite similar to minimal change - proteinuria / nephrotic syndrome / chronic kidney disease

Focal glomerular deposits of IgM are seen at biopsy.

Treatment:

important to distinguish 1° from 2° FSGS, as pts with the latter should not be treated with immunosuppression, but with optimal BP control with RAA blockade (ACE-i)

• Monitor eGFR, creatinine and protein in 2 weeks; eGFR should not be < 25%; and creatinine should not increase >25%

25% may develop to ESRD