The treatment of idiopathic focal segmental glomerulosclerosis in adults

Adv Chronic Kidney Dis. 2014 Sep;21(5):434-41. doi: 10.1053/j.ackd.2014.03.016.


Focal segmental glomerulosclerosis (FSGS) is the histologic end point of many disease processes that affect the kidney. Clinically, adults with FSGS present with proteinuria that may be accompanied by the nephrotic syndrome. Once identifiable (secondary) causes are excluded, the diagnosis of idiopathic FSGS, a challenging glomerular disease to understand and manage, is made. On the basis of mostly retrospective data, first-line treatment for idiopathic FSGS patients with nephrotic-range proteinuria is a prolonged course of corticosteroids. However, steroid resistance is common and portends an increased risk of long-term decline in kidney function and end-stage kidney disease in these patients compared with responders. Multiple other immunosuppression regimens have been used in steroid-resistant FSGS, some of which have been studied in randomized controlled trials. Here, we review the data on the treatment for idiopathic FSGS in adults.

Keywords: Focal segmental glomerulosclerosis.

Publication types

  • Review

MeSH terms

  • Adult
  • Angiotensin II Type 2 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Glomerulosclerosis, Focal Segmental / complications
  • Glomerulosclerosis, Focal Segmental / drug therapy*
  • Glucocorticoids / therapeutic use
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Immunosuppressive Agents / therapeutic use*
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Nephrotic Syndrome / complications
  • Nephrotic Syndrome / drug therapy*
  • Proteinuria / complications
  • Proteinuria / drug therapy*
  • Treatment Outcome


  • Angiotensin II Type 2 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Glucocorticoids
  • Immunosuppressive Agents
  • Mycophenolic Acid