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Review
. 2014 Mar;9(3):626-32.
doi: 10.2215/CJN.05810513. Epub 2013 Aug 29.

Glomerular diseases: FSGS

Bhadran Bose  1 , Daniel Cattran; Toronto Glomerulonephritis Registry
Affiliations
Review

Glomerular diseases: FSGS

Bhadran Bose et al. Clin J Am Soc Nephrol. 2014 Mar.

Abstract

FSGS is a lesion, not a disease. The separation into primary FSGS (a result of immunologic-mediated injury) versus secondary FSGS (related to a variety of causes) is often difficult. Even when this particular issue is carefully evaluated, the therapeutic implications are not always apparent. Newer literature on both biomarker discovery and on the genetic basis of FSGS is reviewed in this context. In addition, the thorny implications of obesity as it relates to the FSGS lesion are discussed. An overall practical algorithmic approach to the management and treatment of the FSGS lesion that integrates these controversial overlap areas is suggested.

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Figures

Figure 1.
Figure 1.
Overlap of different causal categories of FSGS. There is a complex interaction between different causes of FSGS. The overlap area conceptually indicates patients who may respond to treatment within the overlapping areas of primary and secondary causations.
Figure 2.
Figure 2.
Treatment algorithm for FSGS. *CNI dose as per the KDIGO guidelines on GN. **See the text on options to consider in the management of nonresponders. ***See the text on how to manage relapse. RAS, renin-angiotensin system; CNI, calcineurin inhibitor; MMF, mycophenolate mofetil.
See this image and copyright information in PMC

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