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Focal segmental glomerulosclerosis

Segmental glomerulosclerosis; Focal sclerosis with hyalinosis

 

Focal segmental glomerulosclerosis is scar tissue in the filtering unit of the kidney. This structure is called the glomerulus. The glomeruli serve as filters that help the body get rid of harmful substances. Each kidney has thousands of glomeruli.

"Focal" means that some of the glomeruli become scarred. Others remain normal. "Segmental" means that only part of an individual glomerulus is damaged.

Causes

 

The cause of focal segmental glomerulosclerosis is often unknown.

The condition affects both children and adults. It occurs slightly more often in men and boys. It is also more common in African Americans. Focal segmental glomerulosclerosis causes up to a quarter of all cases of nephrotic syndrome.

Known causes include:

  • Drugs such as heroin, bisphosphonates, anabolic steroids
  • Infection
  • Inherited genetic problems
  • Obesity
  • Reflux nephropathy (a condition in which urine flows backward from the bladder to the kidney)
  • Sickle cell disease
  • Some medicines

 

Symptoms

 

Symptoms may include:

  • Foamy urine (from excess protein in the urine)
  • Poor appetite
  • Swelling, called generalized edema, from fluids held in the body
  • Weight gain

 

Exams and Tests

 

The health care provider will perform a physical exam. This exam may show tissue swelling (edema) and high blood pressure. Signs of kidney (renal) failure and excess fluid may develop as the condition gets worse.

Tests may include:

  • Kidney biopsy
  • Kidney function tests (blood and urine)
  • Urinalysis
  • Urine microscopy
  • Urine protein

 

Treatment

 

Treatments may include:

  • Medicines to reduce the body's inflammatory response.
  • Medicines to lower blood pressure. Some of these medicines also help reduce the amount of protein that spills into the urine.
  • Medicines to get rid of excess fluid (diuretic or "water pill")
  • Low sodium diet to reduce swelling and lower blood pressure

The goal of treatment is to control the symptoms of nephrotic syndrome and prevent chronic kidney failure. These treatments may include:

  • Antibiotics to control infections
  • Fluid restriction
  • Low-fat diet
  • Low- or moderate-protein diet (1 gram of protein per kilogram of body weight per day)
  • Vitamin D supplements
  • Dialysis
  • Kidney transplant

 

Outlook (Prognosis)

 

More than half of those with focal or segmental glomerulosclerosis develop chronic kidney failure within 10 years.

 

Possible Complications

 

Complications may include:

  • Chronic kidney failure
  • End-stage kidney disease
  • Infection
  • Malnutrition
  • Nephrotic syndrome

 

When to Contact a Medical Professional

 

Call your provider if you develop symptoms of this condition, especially if there is:

  • Fever
  • Pain with urination
  • Decreased urine output

 

Prevention

 

No prevention is known.

 

 

References

Appel GB, Radhakrishnan J. Glomerular disorders and nephrotic syndromes In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 121.

Korbet S. Treatment of primary FSGS in adults. JASN. 2012;23(11):1769-76. PMID: 22997260 www.ncbi.nlm.nih.gov/pubmed/22997260.

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Taal MW, Chertow GM, Marsden PA et al, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 31.

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      Male urinary system

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    Tests for Focal segmental glomerulosclerosis

     
       

      Review Date: 5/19/2015

      Reviewed By: Charles Silberberg, DO, Private Practice specializing in nephrology, affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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